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Can Ketoacidosis Cause Chest Pains?

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What is DIABETIC KETOACIDOSIS? What does DIABETIC KETOACIDOSIS mean? DIABETIC KETOACIDOSIS meaning - DIABETIC KETOACIDOSIS definition - DIABETIC KETOACIDOSIS explanation. Source: Wikipedia.org article, adapted under https://creativecommons.org/licenses/... license. SUBSCRIBE to our Google Earth flights channel - https://www.youtube.com/channel/UC6Uu... Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes mellitus. Signs and symptoms may include vomiting, abdominal pain, deep gasping breathing, increased urination, weakness, confusion, and occasionally loss of consciousness. A person's breath may develop a specific smell. Onset of symptoms is usually rapid. In some cases people may not realize they previously had diabetes. DKA happens most often in those with type 1 diabetes, but can also occur in those with other types of diabetes under certain circumstances. Triggers may include infection, not taking insulin correctly, stroke, and certain medications such as steroids. DKA results from a shortage of insulin; in response the body switches to burning fatty acids which produces acidic ketone bodies. DKA is typically diagnosed when testing finds high blood sugar, low blood pH, and ketoacids in either the blood or urine. The primary treatment of DKA is with intravenous fluids and insulin. Depending on the severity, insulin may be given intravenously or by injection under the skin. Usually potassium is also needed to prevent the development of low blood potassium. Throughout treatment blood sugar and potassium levels should be regularly checked. Antibiotics may be required in those with an underlying infection. In those with severely low blood pH, sodium bicarbonate may be given; however, its use is of unclear benefit and typically not recommended. Rates of DKA vary around the world. About 4% of people with type 1 diabetes in United Kingdom develop DKA a year, while in Malaysia the condition affects about 25% a year. DKA was first described in 1886 and, until the introduction of insulin therapy in the 1920s, it was almost universally fatal. The risk of death with adequate and timely treatment is currently around 1–4%. Up to 1% of children with DKA develop a complication known as cerebral edema. The symptoms of an episode of diabetic ketoacidosis usually evolve over a period of about 24 hours. Predominant symptoms are nausea and vomiting, pronounced thirst, excessive urine production and abdominal pain that may be severe. Those who measure their glucose levels themselves may notice hyperglycemia (high blood sugar levels). In severe DKA, breathing becomes labored and of a deep, gasping character (a state referred to as "Kussmaul respiration"). The abdomen may be tender to the point that an acute abdomen may be suspected, such as acute pancreatitis, appendicitis or gastrointestinal perforation. Coffee ground vomiting (vomiting of altered blood) occurs in a minority of people; this tends to originate from erosion of the esophagus. In severe DKA, there may be confusion, lethargy, stupor or even coma (a marked decrease in the level of consciousness). On physical examination there is usually clinical evidence of dehydration, such as a dry mouth and decreased skin turgor. If the dehydration is profound enough to cause a decrease in the circulating blood volume, tachycardia (a fast heart rate) and low blood pressure may be observed. Often, a "ketotic" odor is present, which is often described as "fruity", often compared to the smell of pear drops whose scent is a ketone. If Kussmaul respiration is present, this is reflected in an increased respiratory rate.....

Diabetic Ketoacidosis Guidelines

Diabetic ketoacidosis is a complication of diabetes mellitus that results in blood glucose levels of more than 250 mg/dL, a serum bicarb level of less than 18 mEq/l, a blood pH level of less than 7.3, increased serum ketone levels, and clinical hydration. The main cause of diabetic ketoacidosis (DKA) is a lack of insulin in the body. Diabetic ketoacidosis can happen in any type of diabetic and in diabetics of all ages; however, it is most commonly seen in type 1 diabetics. Statistically, 14 percent of DKA occurs in people who are 70 years of age or older, 23 percent of DKA is seen in people between 51 and 70, 27 percent is seen in those 30 to 50 years of age, while 36 percent occur in people who are under 30 years of age. About one to five percent of people with DKA ultimately die from their condition. About a third of all people with DKA do not know they have diabetes before having their first bout of ketoacidosis. Typical symptoms seen in the disease include weight loss, increased thirst, increased frequency of urination, abdominal pain, shortness of breath, nausea and vomiting, and a history of a recent fever. Even though there have been many advances in the treatment of DKA, th Continue reading >>

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  1. hmb13

    I'm on Day 7 and feeling like crap. I've had a blazing headache pretty much continuous since Day 2. At first I thought it was due to the caffeine withdrawal, but now that I'm on Day 7, it can't possibly be that. In addition, my head just feels like it's in a fog -- I can't concentrate or focus very well, my energy levels are incredibly low, my mouth feels like cotton and I'm drinking water constantly, and for the past couple days I've started to feel minor chest pains (like someone is squeezing my heart).
    My cousin, who is a nurse, warned me this cleanse might send me into ketosis, which can become acidosis, and both conditions are unhealthy and put stress on the liver. Can someone please explain? Are my symptoms a sign of ketosis or acidosis? I was doing the Whole30 to hopefully change my relationship with food (always an adversarial relationship before -- restriction mentality) and to cleanse my gut from inflammatory foods, but so far it's just making me feel terrible. I had probably a 75% compliant diet before starting Whole30, so this hasn't been a huge shift for me -- what I'm experiencing *isn't* just "carb flu".
    Here's what my typical meals have been:
    Breakfast
    -1 cup coffee (black)
    -2 eggs & 2-3 slices of bacon, or 1/2 sweet potato & 2-3 slices bacon, or 1 C. spaghetti squash w/1/3 c. browned ground pork & sauteed sweet peppers (for any of these, I would use 1/2 tsp. or so of coconut oil in the pan)
    -1/2 - 3/4 c. berries & bananas
    Lunch
    -Salad of mixed greens, assorted fresh veggies, 1/2 c. browned ground pork w/homemade balsamic vinagrette
    Afternoon snack
    -Handful of nuts, a piece of fruit, or fresh veggie slices
    **Sometimes I'm so ravenous by the time I get home, I have to have another snack of a hard-boiled egg the minute I walk in the door in order to have enough energy to cook dinner
    Dinner
    I've been cooking a lot of the meals from the WellFed book -- Moroccan Meatballs over spaghetti squash with cumin carrots on the side, or Salmon a l'Afrique du Nord with Brussels Sprouts. Last night I had grilled lamb & veggie kabobs.
    I've also been taking fermented cod liver oil supplements every day (I'm Vit D deficient).
    Can someone please help? Do I just need to stick it out a while longer, or am I doing something wrong? I'm becoming ineffective at work between this constant headache and the low energy levels. My cousin is begging me to at least eat gluten-free oats or white rice so I get some energy that is more easily available to my brain.
    Help before I give this up completely!

  2. Robin Strathdee

    First question: Do you exercise? If you do, there's no way your carb intake is enough to support your activity levels. If you don't, you could possibly be okay, but if you're used to a higher carb intake then your body is probably freaking out. I would suggest making sure you have a starchy carb at every meal and see if that helps your energy levels smooth out. The Whole30 is not intended to be a specifically low carb program, and from what I understand ketosis and ketoacidosis come from an extreme absence of carbohydrate in the diet (I'll check in with Melissa for confirmation).
    Second question: Could you be coming down with an illness? It's really common for all the changes in your body during a Whole30 to temporarily lower your defenses and make you a little more susceptible to nasty little bugs.
    I'm going to pass this question on to Melissa, too, in case she has anything to add.

  3. Emily

    I agree with your cousin that you need more carbs, but get them from sweet potatoes, spaghetti squash, acorn squash, butternut squash, pumpkin (I love this time of year) instead of grains. And hang in there- you are right in the toughest part.

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Welcome to the Advanced Diabetes CME at Samatvam Jnana Sanjeevini. Please click the link and join the google hang out on air. Happy learning. Happy healthy peaceful prosperous 2018 and beyond. "Advanced Course on Practical Diabetes Care Clinical Pearls Problem Solving Samatvam Jnana Sanjeevini" 19 December 2017, Tuesday, 8.30 am to 5.00 pm Registration Free - Two CME Credits awarded by KMC "Venue: Jnana Sanjeevini Diabetes Hospital and Medical Centre, 1st Floor Lecture Hall 2, 1 A Cross Marenahalli, JP Nagar Phase 2; Bangalore 560078, India, Phone: 91 - 80 - 26493040 " "RSVP: Ashwini KJ, 8971480692, [email protected] " "1. Dr Vikas Satyananda - Transplant Surgeon, University of California, Los Angeles 2. Dr Shayanth - Psychiatrist, NIMHANS, Bangalore 3. Dr S Srikanta - Consultant, Endocrinologist, Bangalore 4. Dr Sharda A - Consultant, Endocrinologist, Bangalore 5. Dr Tejeswini Deepak -Consultant, Endocrinologist, Bangalore 6. Dr T Kamala - Senior, Endocrinologist, Bangalore " Program Speaker 8.30 am Registration, Assembly and Introduction 09.00 am - 10.30 am Session 1: Advances in glucose monitoring 09.00 am - 09.20 am Conventional Self Monitoring Blood Glucose(BG Meter) Ms Uma Dayashankar 09.20 am - 09.40 am Continuous glucose monitoring - Current status Ms Bina Naik 09.40 am - 10.00 am Continuous glucose monitoring vs Flash glucose monitoring Ms Vibha Rao 10.00 am - 10.20 am Pancreas and Islet cell transplantation : Update Dr Vikas Satyananda 10.20 am - 10.30 am Discussion 10.30 am -10.45 am Tea Break 10.45 am - 12.15 pm Session 2: Advances in Insulin delivery 10.45 am - 11.05 am Multiple Daily Insulin (Basal/Bolus) - Update Dr Pushpa Ravikumar 11.05 am - 11.25 am Insulin pumps and Continuous subcutaneous insulin infusion- Update Dr Sharda.A 11.25 am - 11.45 pm Artificial pancreas and Bioartificial pancreas Dr S Srikanta 11.45 pm - 12.05 pm Childhood diabetes : Do all children need insulin? Dr Reshma Harsha 12.05 pm - 12.15 pm Discussion 12.15 pm - 01.00 pm Lunch 01.00 pm - 02.30 pm Session 3 :Mental Health Challenges 01.00 pm - 01.20 pm Living with Diabetes and being a Diabetic Educator Dr Shuchy Chugh 01.20 pm - 01.40 pm Mental Health Challenges : Psychiatrist's Perspective Dr Shayanth (NIMHANS) 01.40 pm - 02.00 pm "Teaching, Learning and Positive behaviour change towards best health Science and Human Spirit" Dr Nagamani Srinivas 02.00 pm - 02.20 pm Mental Health Challenges : Diabetologist's Perspective Dr T kamala 02.20 pm - 02.30 pm Discussion 02.30 pm - 02.45 pm Tea Break 02.45 pm - 04.15 pm Session 4: Future - Looking ahead 02.45 pm - 03.05 pm Cardiovascular outcome trials with antihyperglycemic agents Dr Tejeswini Deepak 03.05 pm - 03.25 pm Pre Type 1 DM - Pathogenesis, Prediction and Prevention? Dr S Srikanta 03.25 pm - 03.45 pm International Society For Paediatric And Adolescent Diabetes 2017 - Highlights and what's new? Ms Chethana K 03.45 pm - 04.05 pm Living with Diabetes: Chanllenges and Dreams Dr Bhanudev Bhatt 04.05 pm - 04.15 pm Discussion 04.15 pm - 05.00 pm Final Comments, Vote of Thanks and Adjourn "Jnana Sanjeevini Medical Center 2, 1 A Cross Marenahalli, JP Nagar Phase 2; Bangalore 560078, India Phone: 91 - 80 - 26493040, 26493060; "

Diabetic Ketoacidosis: “sneaky” Triggers And Clinical Pearls

Authors: Catherine Reynolds, MD (EM Resident Physician, UT Houston), Kathryn Fisher, MD (EM Resident Physician, UT Houston), and Hilary Fairbrother, MD (EM Attending Physician, UT Houston) // Edited by: Alex Koyfman, MD (@EMHighAK) and Brit Long, MD (@long_brit) Clinical Case #1: The patient is a 45-year-old male with history of type 2 DM and HTN who presents to the emergency department with diffuse abdominal pain, nausea, and vomiting for two days. The patient reports that he was recently started on Invokana (canagliflozin) about two weeks ago for his diabetes, and prior to that he was managing his sugars with diet and exercise alone. The patient has had difficulty keeping any food down over the last two days, but denies shortness of breath, chest pain, or fever. He reports his vomit is non-bilious and non-bloody. His initial finger stick is 84 mg/dL, and your intern states that he “knows that this is not DKA” as the serum glucose is normal. Vital signs showed RR 28, HR 110, BP 152/86, SpO2 98% on room air, T 98.4 F. Labs on presentation reveal a Na of 132 mmol/L, K of 5 mmol/L, Cl of 98 mmol/L, bicarbonate of 10 mmol/L, glucose of 84 mg/dL, and venous pH of 7.1. Venous lactat Continue reading >>

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  1. hmb13

    I'm on Day 7 and feeling like crap. I've had a blazing headache pretty much continuous since Day 2. At first I thought it was due to the caffeine withdrawal, but now that I'm on Day 7, it can't possibly be that. In addition, my head just feels like it's in a fog -- I can't concentrate or focus very well, my energy levels are incredibly low, my mouth feels like cotton and I'm drinking water constantly, and for the past couple days I've started to feel minor chest pains (like someone is squeezing my heart).
    My cousin, who is a nurse, warned me this cleanse might send me into ketosis, which can become acidosis, and both conditions are unhealthy and put stress on the liver. Can someone please explain? Are my symptoms a sign of ketosis or acidosis? I was doing the Whole30 to hopefully change my relationship with food (always an adversarial relationship before -- restriction mentality) and to cleanse my gut from inflammatory foods, but so far it's just making me feel terrible. I had probably a 75% compliant diet before starting Whole30, so this hasn't been a huge shift for me -- what I'm experiencing *isn't* just "carb flu".
    Here's what my typical meals have been:
    Breakfast
    -1 cup coffee (black)
    -2 eggs & 2-3 slices of bacon, or 1/2 sweet potato & 2-3 slices bacon, or 1 C. spaghetti squash w/1/3 c. browned ground pork & sauteed sweet peppers (for any of these, I would use 1/2 tsp. or so of coconut oil in the pan)
    -1/2 - 3/4 c. berries & bananas
    Lunch
    -Salad of mixed greens, assorted fresh veggies, 1/2 c. browned ground pork w/homemade balsamic vinagrette
    Afternoon snack
    -Handful of nuts, a piece of fruit, or fresh veggie slices
    **Sometimes I'm so ravenous by the time I get home, I have to have another snack of a hard-boiled egg the minute I walk in the door in order to have enough energy to cook dinner
    Dinner
    I've been cooking a lot of the meals from the WellFed book -- Moroccan Meatballs over spaghetti squash with cumin carrots on the side, or Salmon a l'Afrique du Nord with Brussels Sprouts. Last night I had grilled lamb & veggie kabobs.
    I've also been taking fermented cod liver oil supplements every day (I'm Vit D deficient).
    Can someone please help? Do I just need to stick it out a while longer, or am I doing something wrong? I'm becoming ineffective at work between this constant headache and the low energy levels. My cousin is begging me to at least eat gluten-free oats or white rice so I get some energy that is more easily available to my brain.
    Help before I give this up completely!

  2. Robin Strathdee

    First question: Do you exercise? If you do, there's no way your carb intake is enough to support your activity levels. If you don't, you could possibly be okay, but if you're used to a higher carb intake then your body is probably freaking out. I would suggest making sure you have a starchy carb at every meal and see if that helps your energy levels smooth out. The Whole30 is not intended to be a specifically low carb program, and from what I understand ketosis and ketoacidosis come from an extreme absence of carbohydrate in the diet (I'll check in with Melissa for confirmation).
    Second question: Could you be coming down with an illness? It's really common for all the changes in your body during a Whole30 to temporarily lower your defenses and make you a little more susceptible to nasty little bugs.
    I'm going to pass this question on to Melissa, too, in case she has anything to add.

  3. Emily

    I agree with your cousin that you need more carbs, but get them from sweet potatoes, spaghetti squash, acorn squash, butternut squash, pumpkin (I love this time of year) instead of grains. And hang in there- you are right in the toughest part.

  4. -> Continue reading
read more
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What is KETOACIDOSIS? What does KETOACIDOSIS mean? KETOACIDOSIS meaning - KETOACIDOSIS definition - KETOACIDOSIS explanation. Source: Wikipedia.org article, adapted under https://creativecommons.org/licenses/... license. SUBSCRIBE to our Google Earth flights channel - https://www.youtube.com/channel/UC6Uu... Ketoacidosis is a metabolic state associated with high concentrations of ketone bodies, formed by the breakdown of fatty acids and the deamination of amino acids. The two common ketones produced in humans are acetoacetic acid and ß-hydroxybutyrate. Ketoacidosis is a pathological metabolic state marked by extreme and uncontrolled ketosis. In ketoacidosis, the body fails to adequately regulate ketone production causing such a severe accumulation of keto acids that the pH of the blood is substantially decreased. In extreme cases ketoacidosis can be fatal. Ketoacidosis is most common in untreated type 1 diabetes mellitus, when the liver breaks down fat and proteins in response to a perceived need for respiratory substrate. Prolonged alcoholism may lead to alcoholic ketoacidosis. Ketoacidosis can be smelled on a person's breath. This is due to acetone, a direct by-product of the spontaneous decomposition of acetoacetic acid. It is often described as smelling like fruit or nail polish remover. Ketosis may also smell, but the odor is usually more subtle due to lower concentrations of acetone. Treatment consists most simply of correcting blood sugar and insulin levels, which will halt ketone production. If the severity of the case warrants more aggressive measures, intravenous sodium bicarbonate infusion can be given to raise blood pH back to an acceptable range. However, serious caution must be exercised with IV sodium bicarbonate to avoid the risk of equally life-threatening hypernatremia. Three common causes of ketoacidosis are alcohol, starvation, and diabetes, resulting in alcoholic ketoacidosis, starvation ketoacidosis, and diabetic ketoacidosis respectively. In diabetic ketoacidosis, a high concentration of ketone bodies is usually accompanied by insulin deficiency, hyperglycemia, and dehydration. Particularly in type 1 diabetics the lack of insulin in the bloodstream prevents glucose absorption, thereby inhibiting the production of oxaloacetate (a crucial molecule for processing Acetyl-CoA, the product of beta-oxidation of fatty acids, in the Krebs cycle) through reduced levels of pyruvate (a byproduct of glycolysis), and can cause unchecked ketone body production (through fatty acid metabolism) potentially leading to dangerous glucose and ketone levels in the blood. Hyperglycemia results in glucose overloading the kidneys and spilling into the urine (transport maximum for glucose is exceeded). Dehydration results following the osmotic movement of water into urine (Osmotic diuresis), exacerbating the acidosis. In alcoholic ketoacidosis, alcohol causes dehydration and blocks the first step of gluconeogenesis by depleting oxaloacetate. The body is unable to synthesize enough glucose to meet its needs, thus creating an energy crisis resulting in fatty acid metabolism, and ketone body formation.

> Hyperglycemia And Diabetic Ketoacidosis

When blood glucose levels (also called blood sugar levels) are too high, it's called hyperglycemia. Glucose is a sugar that comes from foods, and is formed and stored inside the body. It's the main source of energy for the body's cells and is carried to each through the bloodstream. But even though we need glucose for energy, too much glucose in the blood can be unhealthy. Hyperglycemia is the hallmark of diabetes — it happens when the body either can't make insulin (type 1 diabetes) or can't respond to insulin properly (type 2 diabetes). The body needs insulin so glucose in the blood can enter the cells to be used for energy. In people who have developed diabetes, glucose builds up in the blood, resulting in hyperglycemia. If it's not treated, hyperglycemia can cause serious health problems. Too much sugar in the bloodstream for long periods of time can damage the vessels that supply blood to vital organs. And, too much sugar in the bloodstream can cause other types of damage to body tissues, which can increase the risk of heart disease and stroke, kidney disease, vision problems, and nerve problems in people with diabetes. These problems don't usually show up in kids or teens w Continue reading >>

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  1. Clare R

    Burned esophagus after DKA

    I tried "Asking an Expert" but no answer yet on this… I need some advice here.
    I went into DKA over this past weekend. The vomiting burned my esophagus to the point that I can't eat regular foods because it hurts so bad. Has anyone experienced this? How long does the pain last? Any suggestions on how I can relieve the pain in the meantime? It's frustrating… swallowing food causes burning pain all the way from my throat down to my stomach.

  2. sandyfrazzini

    I did have that after one episode of DKA several years ago, only it was like everything I ate would give me really bad acid reflux. I don't recall a sore throat, but what I did have lasted a few weeks and was a real pain. Good luck to you, hope you are feeling better soon.

  3. Clare R

    All they gave me for the esophagus pain in the hospital was aluminum hydroxide (kinda like MOM) and it didn't help. And then they'd bring me a bunch of things I couldn't eat. I did my best and ate what I could, but that wasn't much. Even water was hard to get down. I don't have a problem with Vicodin… I've taken it plenty of times without withdrawal effects. I'm not sure if throat spray would work, unless I maybe took a swig of it before eating, but I doubt that's recommended.

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