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Can Ketoacidosis Cause Fever

Infection As A Trigger Of Diabetic Ketoacidosis In Intensive Care—unit Patients

Infection As A Trigger Of Diabetic Ketoacidosis In Intensive Care—unit Patients

Together with hyperglycemic coma, diabetic ketoacidosis (DKA) is the most severe acute metabolic complication of diabetes mellitus [ 1 ]. Defined by the triad hyperglycemia, acidosis, and ketonuria, DKA can be inaugural or complicate known diabetes [ 2 ]. Although DKA is evidence of poor metabolic control and usually indicates an absolute or relative imbalance between the patient's requirements and the treatment, DKA-related mortality is low among patients who receive standardized treatment, which includes administration of insulin, correction of hydroelectrolytic disorders, and management of the triggering factor (which is often cessation of insulin therapy, an infection, or a myocardial infarction) [ 3–8 ]. Although there is no proof that diabetics are more susceptible to infection, they seem to have more difficulty handling infection once it occurs [ 9 , 10 ]. Indeed, several aspects of immunity are altered in diabetic patients: polymorphonuclear leukocyte function is depressed, particularly when acidosis is present, and leukocyte adherence, chemotaxis, phagocytosis, and bactericidal activity may also be impaired [ 11–15 ]. Joshi et al. [ 10 ] reported recently on the lack of clinical evidence that diabetics are more susceptible to infection than nondiabetic patients. Nevertheless, infection is a well-recognized trigger of DKA. Earlier studies have investigated the prevalence of infection as a trigger of DKA and the impact of antimicrobial treatment [ 2 , 15–18 ]. However, none of these studies were of intensive care unit (ICU) patients only. Furthermore, most were descriptive, included small numbers of patients, used univariate analysis only, and did not designate infection as the sole outcome variable of interest. Efforts to identify correlates of infection h Continue reading >>

Symptoms Of Diabetic Ketoacidosis: What You Need To Know

Symptoms Of Diabetic Ketoacidosis: What You Need To Know

Diabetes can be hard to manage, but not properly controlling the disease can have dangerous and potentially deadly consequences. Ketoacidosis is one of them. This condition happens in people who don’t have enough insulin in their body, perhaps because they have not taken some of their insulin shots. The U.S. National Library of Medicine explains that when insulin is lacking, and the body cannot use ingested sugar as a fuel source, it starts to break down fat, which releases acids called ketones into the bloodstream. In large numbers, those ketones are poisonous and can cause deep, rapid breathing, dry skin and mouth, frequent thirst, a flushed face, headache, nausea, stomach pain, muscle stiffness, muscle aches, frequent urination, difficulty concentrating and fruity-smelling breath. If left untreated, the condition can be fatal, in part because it can eventually cause fluid to build up in the brain and for the heart and kidneys to stop working. There are ways to tell whether you have the condition or are approaching it, the Mayo Clinic says. A routine blood sugar test like the kind diabetics take all the time will show high blood sugar, and there are tests to measure the ketone levels in urine. The American Diabetes Association says that experts usually recommend using a urine test strip to check for ketones when blood glucose levels reach higher than 240 milligrams per deciliter. And when sick with a cold or flu, a person should “check for ketones every four to six hours” to be safe. That’s because infections or other illnesses can increase hormones like adrenaline and cortisol in the body, which then counter the work of insulin — “pneumonia and urinary tract infections are common culprits,” the Mayo Clinic warns. In addition to missed insulin shots and Continue reading >>

Dehydration And Diabetes

Dehydration And Diabetes

Tweet People with diabetes have an increased risk of dehydration as high blood glucose levels lead to decreased hydration in the body. Diabetes insipidus, a form of diabetes that is not linked with high blood sugar levels, also carries a higher risk of dehydration. Symptoms of dehydration The symptoms of dehydration include: Thirst Headache Dry mouth and dry eyes Dizziness Tiredness Dark yellow coloured urine Symptoms of severe dehydration Low blood pressure Sunken eyes A weak pulse and/or rapid heartbeat Feeling confused Lethargy Causes and contributory factors of dehydration The following factors can contribute to dehydration. Having more of these factors present at one time can raise the risk of dehydration: Dehydration and blood glucose levels If our blood glucose levels are higher than they should be for prolonged periods of time, our kidneys will attempt to remove some of the excess glucose from the blood and excrete this as urine. Whilst the kidneys filter the blood in this way, water will also be removed from the blood and will need replenishing. This is why we tend to have increased thirst when our blood glucose levels run too high. If we drink water, we can help to rehydrate the blood. The other method the body uses is to draw on other available sources of water from within the body, such as saliva, tears and taking stored water from cells of the body. This is why we may experience a dry mouth and dry eyes when our blood glucose levels are high. If we do not have access to drink water, the body will find it difficult to pass glucose out of the blood via urine and can result in further dehydration as the body seeks to find water from our body's cells. Treating dehydration Dehydration can be treated by taking on board fluids. Water is ideal because it has no add Continue reading >>

Ketoacidosis: A Diabetes Complication

Ketoacidosis: A Diabetes Complication

Ketoacidosis can affect both type 1 diabetes and type 2 diabetes patients. It's a possible short-term complication of diabetes, one caused by hyperglycemia—and one that can be avoided. Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are two of the most serious complications of diabetes. These hyperglycemic emergencies continue to be important causes of mortality among persons with diabetes in spite of all of the advances in understanding diabetes. The annual incidence rate of DKA estimated from population-based studies ranges from 4.8 to 8 episodes per 1,000 patients with diabetes. Unfortunately, in the US, incidents of hospitalization due to DKA have increased. Currently, 4% to 9% of all hospital discharge summaries among patients with diabetes include DKA. The incidence of HHS is more difficult to determine because of lack of population studies but it is still high at around 15%. The prognosis of both conditions is substantially worsened at the extremes of age, and in the presence of coma and hypertension. Why and How Does Ketoacidosis Occur? The pathogenesis of DKA is more understood than HHS but both relate to the basic underlying reduction in the net effective action of circulating insulin coupled with a concomitant elevation of counter regulatory hormones such as glucagons, catecholamines, cortisol, and growth hormone. These hormonal alterations in both DKA and HHS lead to increased hepatic and renal glucose production and impaired use of glucose in peripheral tissues, which results in hyperglycemia and parallel changes in osmolality in extracellular space. This same combination also leads to release of free fatty acids into the circulation from adipose tissue and to unrestrained hepatic fatty acid oxidation to ketone bodies. Some drugs ca Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

WHAT YOU NEED TO KNOW: What is diabetic ketoacidosis? Diabetic ketoacidosis (DKA) is a life-threatening condition caused by dangerously high blood sugar levels. Your blood sugar levels become high because your body does not have enough insulin. Insulin helps move sugar out of the blood so it can be used for energy. The lack of insulin forces your body to use fat instead of sugar for energy. As fats are broken down, they leave chemicals called ketones that build up in your blood. Ketones are dangerous at high levels. What increases my risk for DKA? Not enough insulin Poorly controlled diabetes Infection or other illness Heart attack, stroke, trauma, or surgery Certain medicines such as steroids or blood pressure medicines Illegal drugs such as cocaine Emotional stress Pregnancy What are the signs and symptoms of DKA? More thirst and more frequent urination than usual Abdominal pain, nausea, and vomiting Blurry vision Dry mouth, eyes, and skin, or your face is red and warm Fast, deep breathing, and a faster heartbeat than normal for you Weak, tired, and confused Fruity, sweet breath Mood changes and irritability How is DKA treated? DKA can be life-threatening. You must get immediate medical attention. The goal of treatment is to replace lost body fluids, and to bring your blood sugar level back to normal. How can I help prevent DKA? The best way to prevent DKA is to control your diabetes. Ask your healthcare provider for more information on how to manage your diabetes. The following may help decrease your risk for DKA: Monitor your blood sugar levels closely if you have an infection, are stressed, sick, or experience trauma. Check your blood sugar levels often. You may need to check at least 3 times each day. If your blood sugar level is too high, give yourself insulin as Continue reading >>

What To Know If You Have Diabetes And The Flu

What To Know If You Have Diabetes And The Flu

When you have diabetes, do your best to avoid getting the flu, or influenza. Everyone has a chance of catching this viral infection, but people with diabetes have a harder time fighting it off. The flu can put added stress in your body, which can affect your blood sugar levels and raise the chance of serious health complications. What Are Symptoms of the Flu? They usually come on quickly and may include: Fever (usually high) Severe aches and pains in the joints and muscles and around the eyes Weakness For in-depth information, see Flu Symptoms: What You Might Feel. Which Medications Are Safe? You can take some over-the-counter medications to ease your symptoms. But make sure you read the label. Avoid products with high amounts of sugar. This often includes liquid cold and flu drugs, cough drops, and liquid cough medicines. Look for sugar-free products instead. For in-depth information, see Flu Treatment: The Basics. How Often Should I Check my Blood Sugar? You'll need to check often while you’re sick. Because you're ill and feel awful anyway, you may not notice changes in your blood sugar levels. Take a reading at least every 3 to 4 hours. Call your doctor about any major changes right away. You may need to adjust your insulin. Check your ketones, if you have type 1 diabetes. If they get too high, you might have diabetic ketoacidosis (DKA), which can cause a coma or even death. High ketones are another reason to call your doctor. What Can I Eat? You may feel really crummy and not hungry or thirsty at all. Still, you have to eat to keep your blood sugar levels steady. Stick with foods from your regular meal plan. Eat about 15 grams of carbs every hour or so, like a slice of toast, 3/4 cup of frozen yogurt, or 1 cup of soup. Continue reading >>

Type 2 Diabetes: 4 Signs Of Trouble

Type 2 Diabetes: 4 Signs Of Trouble

If your glucose levels get out of control, it can lead to serious diabetes problems. Knowing the signs of these diabetes conditions can help you take quick action to resolve them. Diabetes complications can occur if you don't regulate your blood sugar (glucose) levels properly. Blood sugar is produced in your liver and muscles, and most of the food you eat is converted into blood sugar. This is your body's source of energy, but when your blood sugar gets too high, diabetes is the result. Your pancreas produces the hormone insulin, which then carries blood sugar into your cells, where it’s stored and used for energy. When you develop insulin resistance, high levels of sugar build up in your blood instead of your cells and you start to experience signs and symptoms of diabetes. You may notice fatigue, hunger, increased thirst, blurred vision, infections that are slow to heal, pain and numbness in your feet or hands, and increased urination. For awhile, your pancreas will work to keep up with your body’s sugar demand by producing more insulin, but eventually it loses the ability to compensate and serious diabetes complications — including blindness, kidney failure, loss of circulation in your lower extremities, and heart disease — can develop. For most people with diabetes, the target blood sugar level is 70 to 130 mg/dL, but your doctor will work with you to pinpoint your individual target range. Your doctor can also help you learn what to eat and how to keep your blood sugar within a healthy range. Joel Zonszein, MD, director of clinical diabetes at Montefiore Medical Center in New York City, says it’s very important to work with and see your doctor regularly and to consult a diabetes educator. If your diabetes is well-controlled and you're monitoring your bloo Continue reading >>

Diabetes Danger: Warning Over Life-threatening Complications Ketoacidosis And Diabulimia

Diabetes Danger: Warning Over Life-threatening Complications Ketoacidosis And Diabulimia

The condition occurs when the body is unable to use blood sugar (glucose) because there isn't enough insulin. Instead, it breaks down fat as an alternative source of fuel. This causes a build-up of a potentially harmful by-product called ketones. It's fairly common in people with type 1 diabetes and can very occasionally affect those with type 2 diabetes. “It sometimes develops in people who were previously unaware they had diabetes. NRS Healthcare has set out to raise awareness for people suffering with the condition and also highlight other issues including diabulimia, a recently reported condition where young people with diabetes choose not to take their insulin in order to lose weight. Alexandra Lomas, who is living with type 1 diabetes, has spoken out about how her delayed diagnosis led to her going through ketoacidosis and warned how young girls living with diabulimia risk experiencing the same horrific symptoms. “Before I had diabetes I had this long luscious thick hair, it was kind of like my crowning glory. “Six months leading up to my diagnosis I would be brushing my hair and pulling out these great big clumps of hair. “I lost six stone is as many months. I eventually lost so much weight that the sugar in my blood had started to eat away at my muscles. “Leading up to going into hospital was really really difficult. “When I got to the hospital they measured my heart rate and it was at 268 beats a minute - the normal rate is around 60 per minute. I felt like I was having a heart attack. “I recently read a story on diabulimia, where young girls across the UK aren’t taking their insulin as a type 1 diabetic in order to make their blood sugars rise and eat away at their fat and muscle and therefore they keep their weight down. “I wanted to make th Continue reading >>

Diabetic Ketoacidosis In Children

Diabetic Ketoacidosis In Children

WHAT YOU NEED TO KNOW: What is diabetic ketoacidosis? Diabetic ketoacidosis (DKA) is a life-threatening condition caused by dangerously high blood sugar levels. Your child's blood sugar levels become high because his body does not have enough insulin. Insulin helps move sugar out of the blood so it can be used for energy. The lack of insulin forces his body to use fat instead of sugar for energy. As fats are broken down, they leave chemicals called ketones that build up in the blood. Ketones are dangerous at high levels. What increases my child's risk for DKA? Not enough insulin Poorly controlled diabetes Infection or other illness Heart attack, stroke, trauma, or surgery Emotional stress Being female What are the signs and symptoms of DKA? Your child may feel very thirsty, and urinate more than usual. He may have a fever. He may also have any of the following: Dry mouth, eyes, and skin Fast, deep breathing Faster heartbeat than normal for him Abdominal pain, nausea, and vomiting Fruity, sweet breath Mood changes and irritability Feeling very weak, tired, and confused Weight loss How is DKA treated? DKA can be life-threatening. Your child must get immediate medical attention. The goal of treatment is to replace lost body fluids, and to bring blood sugar levels back to normal. How can I help prevent DKA? The best way to prevent DKA is to help your child control his diabetes. Ask your child's healthcare provider for more information on how to manage your child's diabetes. The following may help decrease your child's risk for DKA: Monitor your child's blood sugar levels closely if he has an infection, is stressed, sick, or experiences trauma. Check his blood sugar levels often. You may need to check at least 3 times each day. If your child's blood sugar level is too high, Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

The Facts Diabetic ketoacidosis (DKA) is a condition that may occur in people who have diabetes, most often in those who have type 1 (insulin-dependent) diabetes. It involves the buildup of toxic substances called ketones that make the blood too acidic. High ketone levels can be readily managed, but if they aren't detected and treated in time, a person can eventually slip into a fatal coma. DKA can occur in people who are newly diagnosed with type 1 diabetes and have had ketones building up in their blood prior to the start of treatment. It can also occur in people already diagnosed with type 1 diabetes that have missed an insulin dose, have an infection, or have suffered a traumatic event or injury. Although much less common, DKA can occasionally occur in people with type 2 diabetes under extreme physiologic stress. Causes With type 1 diabetes, the pancreas is unable to make the hormone insulin, which the body's cells need in order to take in glucose from the blood. In the case of type 2 diabetes, the pancreas is unable to make sufficient amounts of insulin in order to take in glucose from the blood. Glucose, a simple sugar we get from the foods we eat, is necessary for making the energy our cells need to function. People with diabetes can't get glucose into their cells, so their bodies look for alternative energy sources. Meanwhile, glucose builds up in the bloodstream, and by the time DKA occurs, blood glucose levels are often greater than 22 mmol/L (400 mg/dL) while insulin levels are very low. Since glucose isn't available for cells to use, fat from fat cells is broken down for energy instead, releasing ketones. Ketones accumulate in the blood, causing it to become more acidic. As a result, many of the enzymes that control the body's metabolic processes aren't able Continue reading >>

Symptoms Of Diabetic Ketoacidosis

Symptoms Of Diabetic Ketoacidosis

Diabetic ketoacidosis, or simply DKA, is one of the complications of diabetes mellitus. It occurs suddenly, is severe and can be life-threatening if neglected. The diabetic ketoacidosis is a complex metabolic state comprising of increased blood glucose levels (hyperglycemia), increased production and presence of ketone acids in the blood (ketonemia) and acidic changes in the internal environment of the body (acidosis). These changes together constitute the diabetic ketoacidosis. Diabetic ketoacidosis is more common in persons with type – 1 as compared to type – 2 diabetes mellitus. Sometimes, it may be the first sign of diabetes mellitus in patients with no previous diagnosis of diabetes. In normal individuals, insulin hormone is produced and secreted by an organ called pancreas. Insulin is necessary for the entry of blood glucose into our cells. Insulin works like a key and unlocks the cellular gates to help glucose enter the cells. The cells use entered glucose to produce energy. In type – 1 diabetes mellitus, the pancreatic cells producing insulin are destroyed. This lack of insulin prevents the entry of blood glucose into our cells as the cellular gates are closed, increasing the blood glucose levels (hyperglycemia). Our body cells starve and cannot utilize glucose for energy despite increased amounts of glucose in our blood. In this starving state, our body burns fats and produces ketones for energy purposes. Ketones have an advantage that they do not need insulin to enter into cells but the ketones also have a disadvantage that they are acidic in nature and when produced in excessive amounts, they change our body environment and make it acidic, which can be life-threatening. The patients often develop ketoacidosis when: They have missed their insulin doses T Continue reading >>

Dengue Hemorrhagic Fever Grade Iii With Diabetic Ketoacidosis: A Case Report.

Dengue Hemorrhagic Fever Grade Iii With Diabetic Ketoacidosis: A Case Report.

Abstract A 16-year-old, previously healthy Thai girl presented with DHF grade III. Fifteen hours after the first episode of shock, she had received an excessive amount of crystalloid isotonic solution and 20 ml per kilograms of Dextran-40 however she still had persistently rapid pulse rate and high hematocrit but also had polyuria with more than 4 ml/kg/hr of urine output. She was re-evaluated. Clinical signs showed severe dehydration with some ascites without signs of pleural effusion. Blood gas revealed increased anion gap metabolic acidosis. The cause of polyuria and metabolic acidosis was identified with hyperglycemia, ketouria and glucosuria. Afterwards she was diagnosed and treated as DHF grade III and DKA. Besides insulin administration, fluid resuscitation was very crucial. Intravenous fluid rehydration was needed while the unnecessary extra-volume could cause massive plasma leakage and later on fluid overload. Volume replacement was adjusted to degree of dehydration when signs of volume overload were monitored closely. She was out of DKA at 14 hours after the start of insulin and the intravenous fluid was stopped at 27 hours (36 hours after the first episode of shock). The final diagnosis was DHF grade III, diabetes mellitus with DKA and hepatitis. Continue reading >>

Diabetic Ketoacidosis (dka)

Diabetic Ketoacidosis (dka)

Diabetic ketoacidosis is an acute metabolic complication of diabetes characterized by hyperglycemia, hyperketonemia, and metabolic acidosis. Hyperglycemia causes an osmotic diuresis with significant fluid and electrolyte loss. DKA occurs mostly in type 1 diabetes mellitus (DM). It causes nausea, vomiting, and abdominal pain and can progress to cerebral edema, coma, and death. DKA is diagnosed by detection of hyperketonemia and anion gap metabolic acidosis in the presence of hyperglycemia. Treatment involves volume expansion, insulin replacement, and prevention of hypokalemia. Diabetic ketoacidosis (DKA) is most common among patients with type 1 diabetes mellitus and develops when insulin levels are insufficient to meet the body’s basic metabolic requirements. DKA is the first manifestation of type 1 DM in a minority of patients. Insulin deficiency can be absolute (eg, during lapses in the administration of exogenous insulin) or relative (eg, when usual insulin doses do not meet metabolic needs during physiologic stress). Common physiologic stresses that can trigger DKA include Some drugs implicated in causing DKA include DKA is less common in type 2 diabetes mellitus, but it may occur in situations of unusual physiologic stress. Ketosis-prone type 2 diabetes is a variant of type 2 diabetes, which is sometimes seen in obese individuals, often of African (including African-American or Afro-Caribbean) origin. People with ketosis-prone diabetes (also referred to as Flatbush diabetes) can have significant impairment of beta cell function with hyperglycemia, and are therefore more likely to develop DKA in the setting of significant hyperglycemia. SGLT-2 inhibitors have been implicated in causing DKA in both type 1 and type 2 DM. Continue reading >>

Diabetic Emergencies, Part 5: Dka Case Studies

Diabetic Emergencies, Part 5: Dka Case Studies

Case Study 1 A 32-year-old male with type 1 diabetes since the age of 14 years was taken to the emergency room because of drowsiness, fever, cough, diffuse abdominal pain, and vomiting. Fever and cough started 2 days ago and the patient could not eat or drink water. He has been treated with an intensive insulin regimen (insulin glargine 24 IU at bedtime and a rapid-acting insulin analog before each meal). On examination he was tachypneic, his temperature was 39° C (102.2° F), pulse rate 104 beats per minute, respiratory rate 24 breaths per minute, supine blood pressure 100/70 mmHg; he also had dry mucous membranes, poor skin turgor, and rales in the right lower chest. He was slightly confused. Rapid hematology and biochemical tests showed hematocrit 48%, hemoglobin 14.3 g/dl (143 g/L), white blood cell count 18,000/ μ l, glucose 450 mg/dl (25.0 mmol/L), urea 60 mg/dl (10.2 mmol/L), creatinine 1.4 mg/dl (123.7 μ mol/L), Na+ 152 mEq/L, K+ 5.3 mEq/L, PO4 3−2.3 mEq/L (0.74 mmol/L), and Cl− 110 mmol/L. Arterial pH was 6.9, PO 2 95 mmHg, PCO 2 28 mmHg, HCO 3−9 mEq/L, and O 2 sat 98%. The result of the strip for ketone bodies in urine was strongly positive and the concentration of β-OHB in serum was 3.5 mmol/L. Urinalysis showed glucose 800 mg/dl and specific gravity 1030. What is your diagnosis? The patient has hyperglycemia, ketosis, and metabolic acidosis. Therefore, he has DKA. In addition, because of the pre-existing fever, cough, localized rales on auscultation and high white blood cell count, a respiratory tract infection should be considered. The patient is also dehydrated and has impaired renal function. Do you need more tests to confirm the diagnosis? Determination of the effective serum osmolality and anion gap should be performed in all patients presenti Continue reading >>

Glucocorticoid-induced Diabetic Ketoacidosis In Acute Rheumatic Fever.

Glucocorticoid-induced Diabetic Ketoacidosis In Acute Rheumatic Fever.

Abstract Glucocorticoids are used as anti-inflammatory agents and are associated with many side effects including hyperglycemia, hypertension, pancreatitis, peptic ulcer, and so on. Hyperglycemia is a common side effect, but ketoacidosis is observed rarely. We present a girl who developed diabetic ketoacidosis after the administration of methylprednisolone during the treatment of acute rheumatic fever. She did not have diabetes and was not obese. She developed ketoacidosis after glucocorticoid therapy. Glucocorticoid-induced insulin resistance, lipolysis, and ketogenesis were likely to have precipitated ketoacidosis. During the treatment of ketoacidosis, the insulin need of the patient was gradually decreased by reducing glucocorticoid dose. In addition to the gradual reduction in glucocorticoid dose, salicylate therapy could be considered the treatment for insulin resistance. In this patient, screening for blood gases and urine was diagnostic in the diagnosis of ketoacidosis. The risk of ketoacidosis as well as hyperglycemia should be considered in the course of glucocorticoid therapy. Continue reading >>

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