Acute Confusion in a Diabetic Patient
OVERVIEW
- The causes of confusion or altered LOC in a middle aged diabetic male are numerous.
- Most causes could be delineated by a thorough history, examination and a few simple investigations.
IMPORTANT CAUSES
- Hypoglycaemia – history of hypo’s, episode in relation to taking medications, BSL.
- Diabetic ketoacidosis – history of DKA, polyuria, polydipsia, thrist, compliance with medications, type I or II diabetes, ABG, BSL, dehydration on examination.
- Hyper-osmotic hyperosmolar syndrome (HHS) – unwell with concomitant infection, severe dehydration, severe hyperglycaemia, hyperosmolality (plasma).
- Hyperglycaemia – history of control, compliance, BSL.
- Lactic acidosis – type II diabetics on metformin (biguanides) -> sepsis or renal failure.
- Cerebrovascular accident – TIA or stroke – DM is a risk factor for vascular disease, history of focal neurological symptoms, brainstem or cortical infarct/bleeding.
- Sepsis with encephalopathy – the diabetic patient is at risk of systemic infections from a number of sources.
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC
