Dka Potassium Replacement

Share on facebook

Childhood Ketoacidosis

Patient professional reference Professional Reference articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use. You may find one of our health articles more useful. Diabetic ketoacidosis (DKA) is the leading cause of mortality in childhood diabetes.[1]The primary cause of DKA is absolute or relative insulin deficiency: Absolute - eg, previously undiagnosed type 1 diabetes mellitus or a patient with known type 1 diabetes who does not take their insulin. Relative - stress causes a rise in counter-regulatory hormones with relative insulin deficiency. DKA can be fatal The usual causes of death are: Cerebral oedema - associated with 25% mortality (see 'Cerebral odedema', below). Hypokalaemia - which is preventable with good monitoring. Aspiration pneumonia - thus, use of a nasogastric tube in the semi-conscious or unconscious is advised. Deficiency of insulin. Rise in counter-regulatory hormones, including glucagon, cortisol, growth hormone, and catecholamines. Thus, inappropriate gluconeogenesis and liver glycogenolysis occur compounding the hyperglycaemia, which causes hyperosmolarity and ensui Continue reading >>

Share on facebook

Popular Questions

  1. RawNut

    Humans are unique in their remarkable ability to enter ketosis. They’re also situated near the top of the food chain. Coincidence?
    During starvation, humans rapidly enter ketosis; they do this better than king penguins, and bears don’t do it at all.
    Starvation ketosis
    Humans maintain a high level of functionality during starvation. We can still hunt & plan; some would even argue it’s a more finely tuned state, cognitively. And that’s important, because if we became progressively weaker and slower, chances of acquiring food would rapidly decline.
    Perhaps this is why fasting bears just sleep most of the time: no ketones = no bueno..?
    Observation: chronic ketosis is relatively rare in nature. Angelo Coppola interpreted that to mean animals may have evolved a protective mechanism against ketosis (if you were following along, please let me know if this is a misrepresentation).
    But I think that is misguided. Animals with a low brain/carcass weight ratio (ie, small brain) don’t need it. Babies and children have a higher brain/carcass weight ratio, so they develop ketosis more rapidly than adults. Is this a harmful process? No! It’s an evolutionary adaptation which supports the brain.
    The brain of newborn babies consumes a huge amount of total daily energy, and nearly half comes from ketones. A week or so later, even after the carbohydrate content of breast milk increases, they still don’t get “kicked out of ketosis” (Bourneres et al., 1986). If this were a harmful state, why would Nature have done this? …and all those anecdotes, like babies learn at incredibly rapid rates… coincidence? Maybe they’re myths. Maybe not.
    Ketosis in the animal kingdom
    Imagine a hibernating bear: huge adipose tissue but small brain fuel requirement relative to body size and total energy expenditure. No ketosis, because brain accounts for less than 5% of total metabolism. In adult humans, this is around 19-23%, and babies are much higher (eg, Cahill and Veech, 2003 & Hayes et al., 2012).
    A possible exception to this is ruminant ketosis, but that’s for a different reason. They become ketotic because: 1) their gut turns much of what they eat into a ketogenic diet; and 2) this frequently happens during lactation, which combines very high energy expenditure and an enhanced draw on the oxaloacetate pool to make lactose.
    Whales? Nope. Despite eating for like, 1 month out of the year, they don’t develop ketosis.
    Snakes will enter ketosis, not due to high brain needs per se, but likely because even though small brain, total energy expenditure is so low that brain metabolism easily surpasses the [theoretical] 5% threshold (McCue 2006):
    Fasting baby elephant seals get ketotic, because their babies (Castellini and Costa, 1990):
    Hypercarnivores (eg, cats) don’t develop ketosis on very low carb diets, like humans would, which seems to be due to their inability to down regulate protein catabolism (urea cycle takes care of the nitrogen; gluconeogenesis the carbon)… but they will do so readily during starvation because of relatively big brains (Blanchard et al., 2002):
    Similar to cats, dolphins are carnivorous and also exhibit what appears to be a pathological inability to reduce protein catabolism when necessary. However, unlike cats, dolphins fail to develop ketosis of any sort, whether it’s on their typical low carb diet of fatty fish, or even complete starvation!
    Dolphins are the exception to a lot of rules. I don’t know why. Most animals with big brains have the ability to enter ketosis, but none do it as well as humans.
    Historically, while intermittent or cyclical ketosis was likely more common than nutritional [chronic] ketosis in humans, this doesn’t mean one form is better than another. Common =/= optimal.
    Starvation ketosis isn’t nutritional ketosis, but much of what we know about the latter stems from our understanding of the former… this is getting better, with more and more studies of longer and longer durations being published regularly. And hint: chronic ketosis doesn’t dissolve bones, deteriorate cognitive function, or break your metabolism.
    Are ketones the brain’s preferred fuel?
    Well, let’s just say this: when there are more ketones than glucose, brain uses more ketones than glucose. This happens in both starvation and nutritional ketosis.
    Ketosis proportionately spares glucose utilization in the brain (Zhang et al., 2013)
    If ketones were harmful, Nature would’ve surely devised a way to protect the brain!
    Disclosure: I’m not keto, not even very low carb in the summer really, so this obviously isn’t some sort of confirmation bias or logic fail or whatever you call it. I don’t practice what I preach. Sue me.
    Most of the time, I advocate a plant-based low-carb Paleo-like diet for health; keto if obese insulin resistant. High[ish] protein for all (ymmv). Seasonal when possible.
    Impact of ketones on cognition
    Would our ability to plan and set traps to acquire food, or quickly devise a strategy to escape predation have been negatively impacted during periods of intermittent or cyclical ketosis? I think not; more likely the opposite. And while I [still] believe the physical feats required to do these is not hindered after ketoadaptation, I also [still] believe it’s because we *out-smarted* them, not out-ran them. Compared to many other species, humans suck at speed.
    Some evidence:
    1. acute: in patients with moderate cognitive impairment or Alzheimer’s disease, given 40 mL MCTs to bolster ketoneshttp://ir-na.amazon-adsystem.com/e/...=1&a=B0019LRY8A: cognitive performance improved roughly in parallel with increasing ketones (Reger et al., 2004).
    2. chronic: 20 grams of Axona (purified MCTs) daily for 90 days improved cognition in people with age-associated memory impairment (Constantini et al., 2008).
    3. cruel and unusual: expose a group of type 1 diabetic patients to experimental hypoglycemia and give half 40 grams of coconut oilhttp://ir-na.amazon-adsystem.com/e/...=1&a=B003OGKCDC (which is like a longer-chained version of MCTs) (Page et al., 2009). Result? Hypoglycemia impairs cognition; however, this is largely offset by increasing ketones with coconut oil. This group experienced improved: 1) verbal memory; 2) delayed verbal memory; and 3) verbal memory recognition.
    4. nutritional ketosis: 6 weeks of a bona fide ketogenic diet in patients with mild cognitive impairment = improved verbal memory performance, and this positively correlated with ketones (Krikorian et al., 2012).
    Optimal, harmful, or somewhere in between? You decide (but if you choose harmful, please provide a link! or at least explain why, very clearly…)
    Hint: nutritional ketosis isn’t harmful. FOR. FIVE. YEARS… 1) that’s not cyclical or intermittent ketosis; and 2) five years is probably much longer than the diet you’re following has been tested for “safety.”
    Ketones in evolution
    Without our ability to rapidly enter a robust state of ketosis, we wouldn’t be here, or we’d be some weaker subhuman species. But ketones have been around for a while… some bacteria store energy in the form of poly-beta-hydroxybutyrate. Some prokaryotes use ketones instead of triacylglycerols. Archaea also use ketones; and they’ve been around for billions of years… it’s estimated that we’ve been doing it for quite a long time, too (from evidence on when our brain would’ve surpassed the [theoretical] threshold). I’d cite a study by George Cahill here, and maybe you’d read it. But you should really read all of the studies by George Cahill (it’s not a-whole-lot). Sorry, I know that sounds ‘preachy.’
    Would ketosis have hindered our ability to hunt prey and avoid predation? My thoughts on our ability to perform high intensity physical activity after ketoadaptation have been thoroughly expressed in the past. And ketosis clearly doesn’t hinder cognitive functioning.
    So, from both a mental and physical perspective, ketosis, chronic or otherwise, did not stop us from becoming who we are. Indeed, it probably contributed to how we did so. Well, that and seafood.

  2. keith v

    Wow thanks Rawnut, that was very interesting.
    It especially makes mouse studies suspect due to the mouses small brain

  3. teaser

    An aspect to this that I find interesting is the idea that ketones spare fat. An animal like an elephant seal with its relatively smaller brain and larger fat mass can afford to fuel its glucose cycle from glycerol almost exclusively. If we wanted to do the same trick, and needed 100-125 grams of glucose a day to fuel our brains--at around ten percent of triglyceride calories as glycerol, we'd have to burn through 4000-5000 calories of fat a day during complete starvation, obviously not a good strategy for a person with what used to be "normal" fat stores.

  4. -> Continue reading
read more close

Related Articles

  • Dka Potassium Replacement

    Diabetic ketoacidosis (DKA) is a potentially fatal metabolic disorder presenting most weeks in most accident and emergency (A&E) departments.1 The disorder can have significant mortality if misdiagnosed or mistreated. Numerous management strategies have been described. Our aim is to describe a regimen that is based, as far as possible, on available evidence but also on our experience in managing patients with DKA in the A&E department and on inpa ...

    ketosis Jan 14, 2018
  • How Does Dka Affect Potassium?

    A A A Diabetic Ketoacidosis Diabetic ketoacidosis (DKA) results from dehydration during a state of relative insulin deficiency, associated with high blood levels of sugar level and organic acids called ketones. Diabetic ketoacidosis is associated with significant disturbances of the body's chemistry, which resolve with proper therapy. Diabetic ketoacidosis usually occurs in people with type 1 (juvenile) diabetes mellitus (T1DM), but diabetic keto ...

    ketosis Dec 30, 2017
  • Potassium Shift In Dka

    The effects of acid-base balance on serum potassium are well known.1 Maintenance of extracellular K+ concentration within a narrow range is vital for numerous cell functions, particularly electrical excitability of heart and muscle.2 However, maintenance of normal extracellular K+ (3.5 to 5 mEq/L) is under two potential threats. First, as illustrated in Figure 1, because some 98% of the total body content of K+ resides within cells, predominantly ...

    ketosis Jan 6, 2018
  • Diabetic Ketoacidosis Fluid Replacement

    OVERVIEW potentially life-threatening complication of diabetes melitus resulting from the consequences of insulin deficiency Diagnostic criteria pH < 7.3 ketosis (ketonemia or ketonuria) HCO3 <15 mmol/L due to high anion gap metabolic acidosis (HAGMA) hyperglycemia (may be mild; euglycemic DKA can occur) PATHOGENESIS increased glucagon, cortisol, catcholamines, GH decreased insulin -> hyperglycaemia -> hyperosmolality + glycosuria -> electrolyte ...

    diabetes Dec 31, 2017
  • Diabetic Meal Replacement Shakes

    Glucerna is a brand of meal replacement shakes and bars. It is made by Abbott, and designed specifically for people with type 2 diabetes. Those with prediabetes and type 1 diabetes may also use Glucerna. These products are low in calories and sugar and high in protein. They also contain artificial sweeteners such as sucralose and acesulfame potassium, which may cause potential health risks. When Glucerna is used as part of a healthy diabetes diet ...

    diabetes Jan 14, 2018
  • Meal Replacement Drinks For Diabetics

    We all know that being physically active, buying fresh ingredients and cooking healthy homemade foods is the best route to long-term weight loss and maintenance. However, despite our best efforts, we don’t always have the time or inclination to prepare our own meals, or sometimes we really do need to lose weight fast. Are there any real alternatives for people with diabetes? The answer is a qualified yes. Very low-energy diets (VLEDs) are a spe ...

    diabetes Feb 26, 2018

Popular Articles

More in ketosis

Whoops, looks like something went wrong.