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Dka Lab Values

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Diabetic Ketoacidosis Definition Diabetic ketoacidosis is a dangerous complication of diabetes mellitus in which the chemical balance of the body becomes far too acidic. Description Diabetic ketoacidosis (DKA) always results from a severe insulin deficiency. Insulin is the hormone secreted by the body to lower the blood sugar levels when they become too high. Diabetes mellitus is the disease resulting from the inability of the body to produce or respond properly to insulin, required by the body to convert glucose to energy. In childhood diabetes, DKA complications represent the leading cause of death, mostly due to the accumulation of abnormally large amounts of fluid in the brain (cerebral edema). DKA combines three major features: hyperglycemia, meaning excessively high blood sugar kevels; hyperketonemia, meaning an overproduction of ketones by the body; and acidosis, meaning that the blood has become too acidic. Insulin deficiency is responsible for all three conditions: the body glucose goes largely unused since most cells are unable to transport glucose into the cell without the presence of insulin; this condition makes the body use stored fat as an alternative source instead of the unavailable glucose for energy, a process that produces acidic ketones, which build up because they require insulin to be broken down. The presence of excess ketones in the bloodstream in turn causes the blood to become more acidic than the body tissues, which creates a toxic condition. Causes and symptoms DKA is most commonly seen in individuals with type I diabetes, under 19 years of age and is usually caused by the interruption of their insulin treatment or by acute infection or trauma. A small number of people with type II diabetes also experience ketoacidosis, but this is rare give Continue reading >>

Diabetic Ketoacidosis - Symptoms

Diabetic Ketoacidosis - Symptoms

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 ketoacidosis can develop in any person with diabetes. Since type 1 diabetes typically starts before age 25 years, diabetic ketoacidosis is most common in this age group, but it may occur at any age. Males and females are equally affected. Diabetic ketoacidosis occurs when a person with diabetes becomes dehydrated. As the body produces a stress response, hormones (unopposed by insulin due to the insulin deficiency) begin to break down muscle, fat, and liver cells into glucose (sugar) and fatty acids for use as fuel. These hormones include glucagon, growth hormone, and adrenaline. These fatty acids are converted to ketones by a process called oxidation. The body consumes its own muscle, fat, and liver cells for fuel. In diabetic ketoacidosis, the body shifts from its normal fed metabolism (using carbohydrates for fuel) to a fasting state (using fat for fuel). The resulting increase in blood sugar occurs, because insulin is unavailable to transport sugar into cells for future use. As blood sugar levels rise, the kidneys cannot retain the extra sugar, which is dumped into the urine, thereby increasing urination and causing dehydration. Commonly, about 10% of total body fluids are lost as the patient slips into diabetic ketoacidosis. Significant loss of potassium and other salts in the excessive urination is also common. The most common Continue reading >>

The Highs And Lows Of Dka

The Highs And Lows Of Dka

Kumar, Coleen P. RN, MS Q: What's diabetic ketoacidosis (DKA)? A: A disorder associated with a reduction in circulating insulin that results in hyperglycemia, DKA is one of the most serious acute complications of diabetes. In addition to the reduction of circulating insulin, an elevation in counterregulatory hormones, such as glucagon, catecholamines, cortisol, and growth hormone, leads to an increase in glucose production in the liver and kidneys, impaired use of glucose in the peripheral tissues, and the release of free fatty acids from adipose tissue into the circulation (lipolysis). The liver oxidizes fatty acids to ketone bodies, which results in excess ketones in the blood (ketonemia) and metabolic acidosis. The most common cause associated with DKA is infection. Other factors include stroke, alcohol abuse, pancreatitis, myocardial infarction, trauma, the use of drugs that affect carbohydrate breakdown (such as corticosteroids, thiazides, and sympathomimetic agents), and incorrect insulin administration or missed doses. DKA occurs more often in adults than children. At times a patient with diabetes may not take his insulin as prescribed for a variety of reasons, such as rebellion against authority or resistance to the diagnosis, fear of weight gain, or fear of hypoglycemia. Dealing with the stress of the day-to-day management of a chronic illness may also lead to the development of DKA. The classic signs and symptoms include polyuria, polydipsia, polyphagia, weight loss, vomiting, abdominal pain, dehydration, weakness, and dulled senses. Physical findings may include poor skin turgor, Kussmaul respirations (deep, rapid respirations), tachycardia, hypotension, changes in mental status, shock, and coma. Emesis is often coffee-ground-like in appearance and tests guai Continue reading >>

Diabetic Ketoacidosis (dka)

Diabetic Ketoacidosis (dka)

Snap Shot A 12 year old boy, previously healthy, is admitted to the hospital after 2 days of polyuria, polyphagia, nausea, vomiting and abdominal pain. Vital signs are: Temp 37C, BP 103/63 mmHg, HR 112, RR 30. Physical exam shows a lethargic boy. Labs are notable for WBC 16,000, Glucose 534, K 5.9, pH 7.13, PCO2 is 20 mmHg, PO2 is 90 mmHg. Introduction Complication of type I diabetes result of ↓ insulin, ↑ glucagon, growth hormone, catecholamine Precipitated by infections drugs (steroids, thiazide diuretics) noncompliance pancreatitis undiagnosed DM Presentation Symptoms abdominal pain vomiting Physical exam Kussmaul respiration increased tidal volume and rate as a result of metabolic acidosis fruity, acetone odor severe hypovolemia coma Evaluation Serology blood glucose levels > 250 mg/dL due to ↑ gluconeogenesis and glycogenolysis arterial pH < 7.3 ↑ anion gap due to ketoacidosis, lactic acidosis ↓ HCO3- consumed in an attempt to buffer the increased acid hyponatremia dilutional hyponatremia glucose acts as an osmotic agent and draws water from ICF to ECF hyperkalemia acidosis results in ICF/ECF exchange of H+ for K+ moderate ketonuria and ketonemia due to ↑ lipolysis β-hydroxybutyrate > acetoacetate β-hydroxybutyrate not detected with normal ketone body tests hypertriglyceridemia due to ↓ in capillary lipoprotein lipase activity activated by insulin leukocytosis due to stress-induced cortisol release H2PO4- is increased in urine, as it is titratable acid used to buffer the excess H+ that is being excreted Treatment Fluids Insulin with glucose must prevent resultant hypokalemia and hypophosphatemia labs may show pseudo-hyperkalemia prior to administartion of fluid and insulin due to transcellular shift of potassium out of the cells to balance the H+ be Continue reading >>

Understanding Diabetic Ketoacidosis Lab Values

Understanding Diabetic Ketoacidosis Lab Values

Diabetes can be a difficult condition to monitor. You need to consistently eat right and be aware of even slight changes concerning how you’re feeling physically… especially when there are really scary things that can happen, like diabetic ketoacidosis (DKA). When your cells don’t get the sugar they need to make into energy, your body then starts to burn fat for energy, which produces ketones. This happens when your body doesn’t have enough of the hormone insulin to turn the glucose (sugar) into energy. Excess ketones can be extremely dangerous when they build up in the blood because they can make the blood too acidic. Acidic blood is toxic to your cells and can impair them so they can’t function properly. This causes them to have a hard time fighting bacterias and viruses and they also won’t be able to process the oxygen and nutrients in your blood properly, depleting you of energy. If you’re not careful, this condition could be fatal. Warning Signs of DKA DKA usually occurs over several hours and there are variety of warning signs that you should be aware of to prevent this condition from becoming dangerous. Here are a few symptoms to watch for: Extreme dry mouth or thirst Dry or flushed skin Always feeling tired Difficulty breathing Your breath smells sweet or fruity Confusion or having a hard time paying attention How to Test for DKA If you have diabetes, you should consider buying at home ketone tests to ensure that your blood levels are in the appropriate range at all times. For example, Amazon.com has a variety of easy-to-use tests that are extremely inexpensive. If you are feeling any of the above symptoms, you can simply use a urine sample to know if you are within healthy ketone limits. The test pad will change colors and you can match your test Continue reading >>

Diabetic Ketoacidosis Lab Values

Diabetic Ketoacidosis Lab Values

goha Registered Nurse DKA - fluids, fluids, bicarb, insulin drip, fluids. Get that anion gap closed, get some diabetes education, and a full set of cultures to cover the bases while you're at it. goha Registered Nurse You do see the HCO3 of 6.9, right? And yes, K+ per protocol as it shifts, but that was included in my "fix the gap" comment. jlna Paramedic I agree with the both of you. I think he may have been referring to as the potassium shifts back into the cells and the hydrogen ions shift outwards the original bicarbonate is restored. Her pH was 7.2 which the ADA does not recommend bicarbonate for. However, I don't think with this individual it would have harmed her if given in an isotonic solution since it was so low. I've seen it done both jlna Paramedic It's amazing what the insulin alone does for some people. She had a pretty long QTc initially that decreased significantly to abnormal range by the time I got her. Everything else started to stable out as well. dr-a Anesthesiology Resident I only use buffers when I need to intubate a patient that is very acidic (<7.00) and a low pco2- just to give me a buffer for a rise in pco2 moji Nursing Student jlna Paramedic I personally did not. Unfortunately, in this region, and several other regions alike, people have poorly controlled conditions on account financial inability. Having to choose between medication and food causes us to see people several times a year. Then there's always the case of psychiatric issues or inability/refusal to understand the disease process and importance of taking meds correctly. moji Nursing Student There should be some area programs to help with the med costs. I truly understand the idea of paying for meds or food. I've actually been in that position myself. Help is typically out there it' Continue reading >>

Lab Values And Dka

Lab Values And Dka

Changes in laboratory values often give us clues to what is happening with our patients. I came across the following resource this morning and thought it was worth sharing. Here’s a handy table to help you identify diabetic ketoacidosis (DKA). The following equation can be used to calculate an anion gap: Anion gap = Na+(mEq/L) – [Cl-(mEq/L) + HCO3-(mEq/L)] You have an important role when caring for a patient with DKA. Thorough physical assessments, careful monitoring of laboratory values, and critical thinking are essential to avoid complications of this complex disorder. Have you cared for a patient with DKA? What are the common presenting signs and symptoms? Reference Donahey, E., Folse, S., Weant, K. (2012). Management of Diabetic Ketoacidosis. Advanced Emergency Nursing Journal, 34(3). Continue reading >>

Diabetic Ketoacidosis: Evaluation And Treatment

Diabetic Ketoacidosis: Evaluation And Treatment

Diabetic ketoacidosis is characterized by a serum glucose level greater than 250 mg per dL, a pH less than 7.3, a serum bicarbonate level less than 18 mEq per L, an elevated serum ketone level, and dehydration. Insulin deficiency is the main precipitating factor. Diabetic ketoacidosis can occur in persons of all ages, with 14 percent of cases occurring in persons older than 70 years, 23 percent in persons 51 to 70 years of age, 27 percent in persons 30 to 50 years of age, and 36 percent in persons younger than 30 years. The case fatality rate is 1 to 5 percent. About one-third of all cases are in persons without a history of diabetes mellitus. Common symptoms include polyuria with polydipsia (98 percent), weight loss (81 percent), fatigue (62 percent), dyspnea (57 percent), vomiting (46 percent), preceding febrile illness (40 percent), abdominal pain (32 percent), and polyphagia (23 percent). Measurement of A1C, blood urea nitrogen, creatinine, serum glucose, electrolytes, pH, and serum ketones; complete blood count; urinalysis; electrocardiography; and calculation of anion gap and osmolar gap can differentiate diabetic ketoacidosis from hyperosmolar hyperglycemic state, gastroenteritis, starvation ketosis, and other metabolic syndromes, and can assist in diagnosing comorbid conditions. Appropriate treatment includes administering intravenous fluids and insulin, and monitoring glucose and electrolyte levels. Cerebral edema is a rare but severe complication that occurs predominantly in children. Physicians should recognize the signs of diabetic ketoacidosis for prompt diagnosis, and identify early symptoms to prevent it. Patient education should include information on how to adjust insulin during times of illness and how to monitor glucose and ketone levels, as well as i Continue reading >>

Master Diabetic Ketoacidosis (dka) Diagnosis And Labs With Picmonic For Physician Assistant

Master Diabetic Ketoacidosis (dka) Diagnosis And Labs With Picmonic For Physician Assistant

With Picmonic, facts become pictures. We've taken what the science shows - image mnemonics work - but we've boosted the effectiveness by building and associating memorable characters, interesting audio stories, and built-in quizzing. Dyed-bead-pancreas with Key-to-acidic-lemon and Diagnostic-computer with Test-tubes Picmonic Diabetic ketoacidosis (DKA) is a medical emergency and complication of diabetes. Patients have increased insulin requirements, which leads to a shortage. As a response, the body begins burning excess fat (and fatty acids), causing ketone body buildup Lab values seen in DKA include blood sugars above 250 mg/dL, and anion gap metabolic acidosis with pH below 7.3 and bicarbonate below 18. Patients will also show present plasma ketones. Due to an extracellular shift, patients may be hyperkalemic. Picmonic for Physician Assistant covers information that is relevant to your entire Physician Assistant education. Whether you’re studying for your classes or getting ready to conquer the PANCE, we’re here to help. Research shows that students who use Picmonic see a 331% improvement in memory retention and a 50% improvement in test scores. "I was shocked at how much information and high yield details I was able to recall using Picmonic. I can picture a lot of the Picmonics now and remember the details months later!" - Katrina, New York College of Osteopathic Medicine of NYIT TRY IT FREE Continue reading >>

Common Laboratory (lab) Values - Abgs

Common Laboratory (lab) Values - Abgs

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z Laboratory VALUES Home Page Arterial Blood Gases Arterial blood gas analysis provides information on the following: 1] Oxygenation of blood through gas exchange in the lungs. 2] Carbon dioxide (CO2) elimination through respiration. 3] Acid-base balance or imbalance in extra-cellular fluid (ECF). Normal Blood Gases Arterial Venous pH 7.35 - 7.45 7.32 - 7.42 Not a gas, but a measurement of acidity or alkalinity, based on the hydrogen (H+) ions present. The pH of a solution is equal to the negative log of the hydrogen ion concentration in that solution: pH = - log [H+]. PaO2 80 to 100 mm Hg. 28 - 48 mm Hg The partial pressure of oxygen that is dissolved in arterial blood. New Born – Acceptable range 40-70 mm Hg. Elderly: Subtract 1 mm Hg from the minimal 80 mm Hg level for every year over 60 years of age: 80 - (age- 60) (Note: up to age 90) HCO3 22 to 26 mEq/liter (21–28 mEq/L) 19 to 25 mEq/liter The calculated value of the amount of bicarbonate in the bloodstream. Not a blood gas but the anion of carbonic acid. PaCO2 35-45 mm Hg 38-52 mm Hg The amount of carbon dioxide dissolved in arterial blood. Measured. Partial pressure of arterial CO2. (Note: Large A= alveolor CO2). CO2 is called a “volatile acid” because it can combine reversibly with H2O to yield a strongly acidic H+ ion and a weak basic bicarbonate ion (HCO3 -) according to the following equation: CO2 + H2O <--- --> H+ + HCO3 B.E. –2 to +2 mEq/liter Other sources: normal reference range is between -5 to +3. The base excess indicates the amount of excess or insufficient level of bicarbonate in the system. (A negative base excess indicates a base deficit in the blood.) A negative base excess is equivalent to an acid excess. A value outside of the normal r Continue reading >>

Diabetic Ketoacidosis And Hyperosmolar Hyperglycemic State In Adults: Clinical Features, Evaluation, And Diagnosis

Diabetic Ketoacidosis And Hyperosmolar Hyperglycemic State In Adults: Clinical Features, Evaluation, And Diagnosis

INTRODUCTION Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS, also known as hyperosmotic hyperglycemic nonketotic state [HHNK]) are two of the most serious acute complications of diabetes. DKA is characterized by ketoacidosis and hyperglycemia, while HHS usually has more severe hyperglycemia but no ketoacidosis (table 1). Each represents an extreme in the spectrum of hyperglycemia. The precipitating factors, clinical features, evaluation, and diagnosis of DKA and HHS in adults will be reviewed here. The epidemiology, pathogenesis, and treatment of these disorders are discussed separately. DKA in children is also reviewed separately. (See "Diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults: Epidemiology and pathogenesis".) Continue reading >>

Diagnosis And Treatment Of Diabetic Ketoacidosis And The Hyperglycemic Hyperosmolar State

Diagnosis And Treatment Of Diabetic Ketoacidosis And The Hyperglycemic Hyperosmolar State

Go to: Pathogenesis In both DKA and HHS, the underlying metabolic abnormality results from the combination of absolute or relative insulin deficiency and increased amounts of counterregulatory hormones. Glucose and lipid metabolism When insulin is deficient, the elevated levels of glucagon, catecholamines and cortisol will stimulate hepatic glucose production through increased glycogenolysis and enhanced gluconeogenesis4 (Fig. 1). Hypercortisolemia will result in increased proteolysis, thus providing amino acid precursors for gluconeogenesis. Low insulin and high catecholamine concentrations will reduce glucose uptake by peripheral tissues. The combination of elevated hepatic glucose production and decreased peripheral glucose use is the main pathogenic disturbance responsible for hyperglycemia in DKA and HHS. The hyperglycemia will lead to glycosuria, osmotic diuresis and dehydration. This will be associated with decreased kidney perfusion, particularly in HHS, that will result in decreased glucose clearance by the kidney and thus further exacerbation of the hyperglycemia. In DKA, the low insulin levels combined with increased levels of catecholamines, cortisol and growth hormone will activate hormone-sensitive lipase, which will cause the breakdown of triglycerides and release of free fatty acids. The free fatty acids are taken up by the liver and converted to ketone bodies that are released into the circulation. The process of ketogenesis is stimulated by the increase in glucagon levels.5 This hormone will activate carnitine palmitoyltransferase I, an enzyme that allows free fatty acids in the form of coenzyme A to cross mitochondrial membranes after their esterification into carnitine. On the other side, esterification is reversed by carnitine palmitoyltransferase I Continue reading >>

Blood Gas Measurements In Dka: Are We Searching For A Unicorn?

Blood Gas Measurements In Dka: Are We Searching For A Unicorn?

Introduction Recently there have been numerous publications and discussions about whether VBGs can replace ABGs in DKA. The growing consensus is that VBGs are indeed adequate. Eliminating painful, time-consuming arterial blood draws is a huge step in the right direction. However, the ABG vs. VBG debate overlooks a larger point: neither ABG nor VBG measurements are usually helpful. It is widely recommended to routinely obtain an ABG or VBG, for example by both American and British guidelines. Why? Is it helping our patients, or is it something that we do out of a sense of habit or obligation? Diagnosis of DKA: Blood gas doesn’t help These are the diagnostic criteria for DKA from the America Diabetes Association. They utilize either pH or bicarbonate in a redundant fashion to quantify the severity of acidosis. It is unclear what independent information the pH adds beyond what is provided by the bicarbonate. Practically speaking, the blood gas doesn’t help diagnose DKA. This diagnosis should be based on analysis of the metabolic derangements in the acid-base status (e.g. anion gap, beta-hydroxybutyrate level). The addition of a blood gas to serum chemistries only adds information about the respiratory status, which does not help determine if the patient has ketoacidosis. Management: Does the pH help? It is debatable whether knowing or attempting to directly “treat” the pH is helpful. The pH will often be very low, usually lower than would be expected by looking at the patient. This may induce panic. However, it is actually a useful reminder that acidemia itself doesn't necessarily cause instability (e.g. healthy young rowers may experience lactic acidosis with a pH <7 during athletic exertion; Volianitis 2001). A question often arises regarding whether bicarbonate Continue reading >>

Lab Test

Lab Test

Measurement of beta-hydroxybutyrate in whole blood, serum, or plasma to evaluate ketone-producing metabolic energy deficits that usually occur when there is insufficient carbohydrate metabolism, thereby increasing the catabolism of fatty acids. Clinical Application Common tests for ketone bodies, such as Acetest, Chemstrip, and Ketostix, do not detect beta-hydroxybutyrate. A handheld meter sensor system is available to monitor beta-hydroxybutyrate and glucose levels. Elevated levels beta-hydroxybutyrate is diagnostic of ketoacidosis, whereas the absence of concomitant hyperglycemia supports the diagnosis of alcoholic ketoacidosis (AKA). Levels ³ 3 mmol/L are indicative of ketoacidosis. In very severe diabetic ketoacidosis (DKA), the beta-hydroxybutyrate serum concentration may exceed 25 mmol/L. Patients presenting with isopropanol intoxication can present with high acetone levels without any acidosis, anion gap or abnormal glucoses levels. Plasma (lithium-heparin or fluoride-oxalate), serum, or perchloric acid (PCA) extracts can be analyzed. EDTA-plasma samples will produce values that are 60% lower than specimens preserved with fluoride-oxalate or PCA. Continue reading >>

Blood Ketones

Blood Ketones

On This Site Tests: Urine Ketones (see Urinalysis - The Chemical Exam); Blood Gases; Glucose Tests Elsewhere On The Web Ask a Laboratory Scientist Your questions will be answered by a laboratory scientist as part of a voluntary service provided by one of our partners, the American Society for Clinical Laboratory Science (ASCLS). Click on the Contact a Scientist button below to be re-directed to the ASCLS site to complete a request form. If your question relates to this web site and not to a specific lab test, please submit it via our Contact Us page instead. Thank you. Continue reading >>

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