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Can Ketoacidosis Cause Stroke

What You Should Know About Diabetic Ketoacidosis

What You Should Know About Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a serious condition that can occur in diabetes. DKA happens when acidic substances, called ketones, build up in your body. Ketones are formed when your body burns fat for fuel instead of sugar, or glucose. That can happen if you don’t have enough insulin in your body to help you process sugars. Learn more: Ketosis vs. ketoacidosis: What you should know » Left untreated, ketones can build up to dangerous levels. DKA can occur in people who have type 1 or type 2 diabetes, but it’s rare in people with type 2 diabetes. DKA can also develop if you are at risk for diabetes, but have not received a formal diagnosis. It can be the first sign of type 1 diabetes. DKA is a medical emergency. Call your local emergency services immediately if you think you are experiencing DKA. Symptoms of DKA can appear quickly and may include: frequent urination extreme thirst high blood sugar levels high levels of ketones in the urine nausea or vomiting abdominal pain confusion fruity-smelling breath a flushed face fatigue rapid breathing dry mouth and skin It is important to make sure you consult with your doctor if you experience any of these symptoms. If left untreated, DKA can lead to a coma or death. All people who use insulin should discuss the risk of DKA with their healthcare team, to make sure a plan is in place. If you think you are experiencing DKA, seek immediate medical help. Learn more: Blood glucose management: Checking for ketones » If you have type 1 diabetes, you should maintain a supply of home urine ketone tests. You can use these to test your ketone levels. A high ketone test result is a symptom of DKA. If you have type 1 diabetes and have a glucometer reading of over 250 milligrams per deciliter twice, you should test your urine for keton Continue reading >>

Em Chapter 19 Diabetic Emergencies And Altered Mental Status

Em Chapter 19 Diabetic Emergencies And Altered Mental Status

A patient who is experiencing a transient ischemic attack​ (TIA) may develop MOST of the same symptoms as a patient who is suffering a stroke. The key difference is that the signs and symptoms of a TIA usually disappear​ within: 24 hours; Patients who experience a TIA develop most of the same signs and symptoms as those who are experiencing a stroke. The key difference between a stroke and a TIA is that the signs and symptoms of a TIA disappear without any obvious permanent neurological deficits. The signs and symptoms of the TIA will typically resolve within one to two hours after the​ onset; however, they may last up to 24 hours. A​ 50-year-old female patient has been found unconscious and unresponsive. She is breathing rapidly and is diaphoretic. Her vital signs are P​ 130, R​ 30, BP​ 140/80. Which of the following conditions would most likely explain these​ findings? Hypoglycemia; Given the​ patient's signs and​ symptoms, the most likely probable cause is diabetes. Diaphoresis and tachycardia are common findings associated with low blood sugar. A TIA can cause altered mental status but rarely results in frank unconsciousness. A​ beta-blocker overdose would result in a slow heart rate and would be far less common than hypoglycemia. Your patient is a​ 19-year-old male who was reportedly unconscious for a brief time. You learn that he regained consciousness in about 30 seconds. You find no evidence of drowsiness or neurological deficits. Which of the following is MOST likely the​ cause? Syncope; On the basis of the​ findings, syncope is the most likely​ cause, as other conditions would likely have a much longer recovery time. Although a seizure would also explain these​ findings, status epilepticus would involve a prolonged seizure​ (l Continue reading >>

Stroke And Diabetic Ketoacidosis – Some Diagnostic And Therapeutic Considerations

Stroke And Diabetic Ketoacidosis – Some Diagnostic And Therapeutic Considerations

Authors Jovanovic A, Stolic R, Rasic D, Markovic-Jovanovic S, Peric V Accepted for publication 8 January 2014 Checked for plagiarism Yes Peer reviewer comments 2 3 1Department of Endocrinology, 2Department of Nephrology, 3Department of Cardiology, 4Department of Pediatrics, University of Pristina–Kosovska Mitrovica, Kosovska Mitrovica, Serbia Abstract: Cerebrovascular insult (CVI) is a known and important risk factor for the development of diabetic ketoacidosis (DKA); still, it seems that the prevalence of DKA among the patients suffering CVI and its influence on stroke outcome might be underestimated. Diabetic ketoacidosis itself has been reported to be a risk factor for the occurrence of stroke in children and youth. A cerebral hypoperfusion in untreated DKA may lead to cerebral injury, arterial ischemic stroke, cerebral venous thrombosis, and hemorrhagic stroke. All these were noted following DKA episodes in children. At least some of these mechanisms may be operative in adults and complicate the course and outcome of CVI. There is a considerable overlap of symptoms, signs, and laboratory findings in the two conditions, making their interpretation difficult, particularly in the elderly and less communicative patients. Serum pH and bicarbonate, blood gases, and anion gap levels should be routinely measured in all type 1 and type 2 diabetics, regardless of symptomatology, for the early detection of existing or pending ketoacidosis. The capacity for rehydration in patients with stroke is limited, and the treatment of the cerebrovascular disease requires intensive use of osmotic and loop diuretics. Fluid repletion may be difficult, and the precise management algorithms are required. Intravenous insulin is the backbone of treatment, although its effect may be diminished Continue reading >>

Dka And Thrombosis

Dka And Thrombosis

Josephine Ho and associates1 report an unfortunate case of a 6-year-old girl with diabetic ketoacidosis (DKA) and thromboembolic stroke. Although the authors do a credible job of describing the diverse causes of pediatric stroke and the controversies surrounding treatment of children, there was little emphasis on the danger of extreme hyperosmolar states and risks of thrombosis. More information about the initial presentation of the patient, with specific reference to the concentration of serum sodium and serum osmolarity, would have been helpful in determining her risks of thrombosis. Diabetes is associated with a prothrombotic state through a number of mechanisms.2 The mostly adult entity of hyperosmolar nonketotic coma has had various degrees of association with thrombosis,2,3 as has extreme hypernatremia in breast-feeding neonates.4 Recent evidence has also demonstrated that among children with DKA, there is a higher incidence of deep venous thrombosis with femoral central venous lines.5,6 Serum glucose and sodium concentrations and hence effective plasma osmolarity were significantly higher in those patients with blood clots.5 Although there is no direct evidence for its efficacy, our practice has been to use prophylactic anticoagulation in patients with DKA who are in a significant hyperosmolar state, as well as to eliminate the use of femoral catheters in patients with these risk factors. There is significant controversy surrounding the dose of anticoagulant therapy, specifically whether the efficacy of dosages for prophylaxis of deep venous thrombosis outweighs the risks associated with full systemic anticoagulation.7 As with most clinical issues, particularly in pediatric critical illness, this controversy lends itself well to a clinical trial in patients with Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

What Is It? Diabetic ketoacidosis is a potentially fatal complication of diabetes that occurs when you have much less insulin than your body needs. This problem causes the blood to become acidic and the body to become dangerously dehydrated. Diabetic ketoacidosis can occur when diabetes is not treated adequately, or it can occur during times of serious sickness. To understand this illness, you need to understand the way your body powers itself with sugar and other fuels. Foods we eat are broken down by the body, and much of what we eat becomes glucose (a type of sugar), which enters the bloodstream. Insulin helps glucose to pass from the bloodstream into body cells, where it is used for energy. Insulin normally is made by the pancreas, but people with type 1 diabetes (insulin-dependent diabetes) don't produce enough insulin and must inject it daily. Subscribe to Harvard Health Online for immediate access to health news and information from Harvard Medical School. Continue reading >>

Complications Of Type 1 Diabetes

Complications Of Type 1 Diabetes

Hypoglycemia is low blood sugar, usually 50-60 milligrams per deciliter (mg/dL) or 2.8-3.3 millimoles per liter (mmol/L). It can be caused by any of the following: Taking too much insulin for the amount of food you ate Taking too much insulin to treat "fasting" blood sugar Skipping a meal or eating a smaller meal than usual without lowering your insulin dose Exercising harder or longer than normal without lowering your insulin dose Hypoglycemia can be managed fairly easily if you are able to recognize the symptoms and treat it right away. The symptoms of hypoglycemia include: Shakiness Sweating Rapid heart rate Lightheadedness Headache Hunger Pale skin color Sudden moodiness or behavior change, such as crying for no apparent reason Clumsy or jerky movements Confusion or difficulty paying attention Tingling sensations around the mouth Passing out leading to coma If you think you are hypoglycemic, test your blood with your blood glucose monitor. If your blood glucose level is below your normal range, treat the hypoglycemia. (If you do not know what your normal blood sugar range is, ask your doctor). Or, if you recognize the symptoms of low blood sugar, you may want to treat it immediately, without waiting to test. If you are just starting treatment, you may feel some of these symptoms when your blood sugar level is close to the normal range for you. This is called relative hypoglycemia. This happens because your body is adjusting from a high blood sugar level to a lower, more normal level. In this case, it is important that you test your level if you feel these symptoms. By testing your blood sugar, you can avoid treating a normal level. If you have had diabetes for a long time or have frequent hypoglycemia, you may lose the ability to sense hypoglycemia with these sympto Continue reading >>

Diabetic Coma

Diabetic Coma

Diabetic coma is a reversible form of coma found in people with diabetes mellitus. It is a medical emergency.[1] Three different types of diabetic coma are identified: Severe low blood sugar in a diabetic person Diabetic ketoacidosis (usually type 1) advanced enough to result in unconsciousness from a combination of a severely increased blood sugar level, dehydration and shock, and exhaustion Hyperosmolar nonketotic coma (usually type 2) in which an extremely high blood sugar level and dehydration alone are sufficient to cause unconsciousness. In most medical contexts, the term diabetic coma refers to the diagnostical dilemma posed when a physician is confronted with an unconscious patient about whom nothing is known except that they have diabetes. An example might be a physician working in an emergency department who receives an unconscious patient wearing a medical identification tag saying DIABETIC. Paramedics may be called to rescue an unconscious person by friends who identify them as diabetic. Brief descriptions of the three major conditions are followed by a discussion of the diagnostic process used to distinguish among them, as well as a few other conditions which must be considered. An estimated 2 to 15 percent of diabetics will suffer from at least one episode of diabetic coma in their lifetimes as a result of severe hypoglycemia. Types[edit] Severe hypoglycemia[edit] People with type 1 diabetes mellitus who must take insulin in full replacement doses are most vulnerable to episodes of hypoglycemia. It is usually mild enough to reverse by eating or drinking carbohydrates, but blood glucose occasionally can fall fast enough and low enough to produce unconsciousness before hypoglycemia can be recognized and reversed. Hypoglycemia can be severe enough to cause un Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Diabetic acidosis is a life-threatening condition that can occur in people with type 1 diabetes. Less commonly, it can also occur with type 2 diabetes. Term watch Ketones: breakdown products from the use of fat stores for energy. Ketoacidosis: another name for diabetic acidosis. It happens when a lack of insulin leads to: Diabetic acidosis requires immediate hospitalisation for urgent treatment with fluids and intravenous insulin. It can usually be avoided through proper treatment of Type 1 diabetes. However, ketoacidosis can also occur with well-controlled diabetes if you get a severe infection or other serious illness, such as a heart attack or stroke, which can cause vomiting and resistance to the normal dose of injected insulin. What causes diabetic acidosis? The condition is caused by a lack of insulin, most commonly when doses are missed. While insulin's main function is to lower the blood sugar level, it also reduces the burning of body fat. If the insulin level drops significantly, the body will start burning fat uncontrollably while blood sugar levels rise. Glucose will then begin to show up in your urine, along with ketone bodies from fat breakdown that turn the body acidic. The body attempts to reduce the level of acid by increasing the rate and depth of breathing. This blows off carbon dioxide in the breath, which tends to correct the acidosis temporarily (known as acidotic breathing). At the same time, the high secretion of glucose into the urine causes large quantities of water and salts to be lost, putting the body at serious risk of dehydration. Eventually, over-breathing becomes inadequate to control the acidosis. What are the symptoms? Since diabetic acidosis is most often linked with high blood sugar levels, symptoms are the same as those for diabetes Continue reading >>

Diabetic Ketoacidosis

Diabetic 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 the Pre-diabetes (Impaired Glucose Tolerance) article more useful, or one of our other health articles. See also the separate Childhood Ketoacidosis article. Diabetic ketoacidosis (DKA) is a medical emergency with a significant morbidity and mortality. It should be diagnosed promptly and managed intensively. DKA is characterised by hyperglycaemia, acidosis and ketonaemia:[1] Ketonaemia (3 mmol/L and over), or significant ketonuria (more than 2+ on standard urine sticks). Blood glucose over 11 mmol/L or known diabetes mellitus (the degree of hyperglycaemia is not a reliable indicator of DKA and the blood glucose may rarely be normal or only slightly elevated in DKA). Bicarbonate below 15 mmol/L and/or venous pH less than 7.3. However, hyperglycaemia may not always be present and low blood ketone levels (<3 mmol/L) do not always exclude DKA.[2] Epidemiology DKA is normally seen in people with type 1 diabetes. Data from the UK National Diabetes Audit show a crude one-year incidence of 3.6% among people with type 1 diabetes. In the UK nearly 4% of people with type 1 diabetes experience DKA each year. About 6% of cases of DKA occur in adults newly presenting with type 1 diabetes. About 8% of episodes occur in hospital patients who did not primarily present with DKA.[2] However, DKA may also occur in people with type 2 diabetes, although people with type 2 diabetes are much more likely to have a hyperosmolar hyperglycaemic state. Ketosis-prone type 2 diabetes tends to be more common in older, overweight, non-white people with type 2 diabetes, and DKA may be their Continue reading >>

Stroke And Diabetic Ketoacidosis – Some Diagnostic And Therapeutic Considerations

Stroke And Diabetic Ketoacidosis – Some Diagnostic And Therapeutic Considerations

Go to: Cerebrovascular insult (CVI) is a known and important risk factor for the development of diabetic ketoacidosis (DKA); still, it seems that the prevalence of DKA among the patients suffering CVI and its influence on stroke outcome might be underestimated. Diabetic ketoacidosis itself has been reported to be a risk factor for the occurrence of stroke in children and youth. A cerebral hypoperfusion in untreated DKA may lead to cerebral injury, arterial ischemic stroke, cerebral venous thrombosis, and hemorrhagic stroke. All these were noted following DKA episodes in children. At least some of these mechanisms may be operative in adults and complicate the course and outcome of CVI. There is a considerable overlap of symptoms, signs, and laboratory findings in the two conditions, making their interpretation difficult, particularly in the elderly and less communicative patients. Serum pH and bicarbonate, blood gases, and anion gap levels should be routinely measured in all type 1 and type 2 diabetics, regardless of symptomatology, for the early detection of existing or pending ketoacidosis. The capacity for rehydration in patients with stroke is limited, and the treatment of the cerebrovascular disease requires intensive use of osmotic and loop diuretics. Fluid repletion may be difficult, and the precise management algorithms are required. Intravenous insulin is the backbone of treatment, although its effect may be diminished due to delayed fluid replenishment. Therefore, the clinical course of diabetic ketoacidosis in patients with CVI may be prolonged and complicated. Keywords: CVI, type 2 diabetes complications, acid-base disturbances, fluid management Go to: Introduction Cerebrovascular incidents (CVI) are significant and well-known risk factors for the development Continue reading >>

Diabetes And Stroke

Diabetes And Stroke

Tweet Stroke is a condition in which blood supply to be the brain is affected. A stroke can sometimes lead to permanent damage including communication problems, paralysis and visual problems. The risk factors of stroke are similar to the risk factors for heart problems. Statistically, people with diabetes have a higher risk of dying from heart disease and stroke than the general population. By maintaining stable blood glucose, blood pressure and cholesterol, people with diabetes can increase their chances of preventing a stroke. What is a stroke? Stroke occurs when blood supply to the brain is interrupted and brain tissue is damaged. The two main types of stroke are: Ischaemic - where a blood clot forms in the brain. This accounts for about 8 out of 10 instances of stroke. Haemorrhagic - whereby a blood vessel in the brain bursts and causes a brain haemorrhage. Stroke can be especially damaging physically, but may also cause mental problems with thought or speech. What are stroke symptoms? The warning signs of a stroke are given the acronym FAST: Face - stroke will often affect muscles on one side of the face causing the mouth or eyes to droop down in contrast with the unaffected side Arms - a person having had a stroke may be unable to hold up one of their arms Speech - slurred speech may be a sign of a stroke Time - refers to the need for urgent action, call 999 immediately if one or more of the symptoms are present Other symptoms of a stroke may include: Sudden numbness or weakness on one side of the body Confusion Trouble seeing Dizziness Loss of balance Double vision Severe headache Sometimes people may experience a stroke without being fully aware that they have had one. This kind of stroke is called a transient ischaemic attack (TIA) and is sometimes referred to Continue reading >>

Diabetic Ketoacidosis And Hyperglycaemic Hyperosmolar State

Diabetic Ketoacidosis And Hyperglycaemic Hyperosmolar State

The hallmark of diabetes is a raised plasma glucose resulting from an absolute or relative lack of insulin action. Untreated, this can lead to two distinct yet overlapping life-threatening emergencies. Near-complete lack of insulin will result in diabetic ketoacidosis, which is therefore more characteristic of type 1 diabetes, whereas partial insulin deficiency will suppress hepatic ketogenesis but not hepatic glucose output, resulting in hyperglycaemia and dehydration, and culminating in the hyperglycaemic hyperosmolar state. Hyperglycaemia is characteristic of diabetic ketoacidosis, particularly in the previously undiagnosed, but it is the acidosis and the associated electrolyte disorders that make this a life-threatening condition. Hyperglycaemia is the dominant feature of the hyperglycaemic hyperosmolar state, causing severe polyuria and fluid loss and leading to cellular dehydration. Progression from uncontrolled diabetes to a metabolic emergency may result from unrecognised diabetes, sometimes aggravated by glucose containing drinks, or metabolic stress due to infection or intercurrent illness and associated with increased levels of counter-regulatory hormones. Since diabetic ketoacidosis and the hyperglycaemic hyperosmolar state have a similar underlying pathophysiology the principles of treatment are similar (but not identical), and the conditions may be considered two extremes of a spectrum of disease, with individual patients often showing aspects of both. Pathogenesis of DKA and HHS Insulin is a powerful anabolic hormone which helps nutrients to enter the cells, where these nutrients can be used either as fuel or as building blocks for cell growth and expansion. The complementary action of insulin is to antagonise the breakdown of fuel stores. Thus, the relea Continue reading >>

Diabetic Emergencies: Warning Signs And What To Do

Diabetic Emergencies: Warning Signs And What To Do

Diabetes symptoms can quickly turn into emergencies. The disease of diabetes was the seventh leading cause of death in the United States in 2010, claiming nearly 70,000 lives. Responding promptly to symptoms of a diabetic emergency can be lifesaving. Causes and types Both type 1 and type 2 diabetes inhibit the body's ability to manage blood sugar levels. Type 1 diabetes does so by destroying the cells that produce insulin. Type 2 diabetes reduces how responsive the body is to insulin, while not enough insulin is produced to counter the sugar in the body. Hence, most diabetic emergencies are related to disruptions in a person's blood sugar levels. Occasionally, even too much of a drug being used to treat diabetes can trigger a diabetic emergency. The most common diabetic emergencies include the following: Severe hypoglycemia Hypoglycemia is when blood sugar levels are abnormally low. When blood sugar dips very low, it becomes a medical emergency. Hypoglycemia normally only occurs in people with diabetes who take medication that lowers blood sugar. Blood sugar levels may drop dangerously low when a person is: consuming too much alcohol exercising, especially without adjusting food intake or insulin dosage missing or delaying meals overdosing on diabetic medication Diabetic ketoacidosis Diabetic ketoacidosis occurs when the body does not have enough insulin to break down glucose properly, and hormones that normally work opposite insulin are high. Over time, the body releases hormones that break down fat to provide fuel. This produces acids called ketones. As ketones build up in the body, ketoacidosis can occur. Common causes of ketoacidosis include: uncontrolled or untreated diabetes an illness or infection that changes hormone production an illness or infection that chang Continue reading >>

Transient Ischemic Attack

Transient Ischemic Attack

A temporary interruption of blood supply (and oxygen) to part of the brain, also known as a ministroke. The symptoms of a transient ischemic attack (TIA) are similar to those of a stroke, which include numbness or weakness in the face, arm, or leg, especially on one side of the body; confusion or difficulty in talking or understanding speech; trouble seeing in one or both eyes; and difficulty with walking, dizziness, or loss of balance or coordination. However, unlike a stroke, the symptoms of a TIA usually go away completely within an hour but may last up to 24 hours (symptoms lasting longer indicate a stroke). Since it is impossible for a person experiencing stroke-like symptoms to tell whether they are the short-lived result of a TIA or the result of a full-blown stroke, they should be considered an emergency if they occur. Time is of the essence when treating a stroke. People who have had a TIA are at great risk for a stroke, so doctors often prescribe certain treatments to reduce the likelihood of a stroke for people who have had a TIA. The most commonly used drugs for preventing strokes are antiplatelet drugs. Antiplatelet drugs make the blood platelets less likely to stick together and form clots. The most frequently used antiplatelet drug, which is the least expensive and has the fewest side effects, is aspirin. Other antiplatelet drugs include clopidogrel (brand name Plavix), ticlopidine (Ticlid), and a combination drug composed of aspirin and dipyridamole (Aggrenox). For someone with a severely narrowed carotid artery (an artery in the neck that supplies blood to the brain), a surgical procedure called carotid endarterectomy may help. In this procedure, atherosclerotic plaque is mechanically cleared out of the carotid artery to restore blood flow to the brain. Continue reading >>

Hyperglycemia And Hypoglycemia In Stroke

Hyperglycemia And Hypoglycemia In Stroke

Practice Essentials Preexisting hyperglycemia worsens the clinical outcome of acute stroke. Nondiabetic ischemic stroke patients with hyperglycemia have a 3-fold higher 30-day mortality rate than do patients without hyperglycemia. In diabetic patients with ischemic stroke, the 30-day mortality rate is 2-fold higher. [1] With regard to hypoglycemia, the condition can mimic acute stroke or symptoms of transient ischemic attack (TIA). [2, 3, 4, 5] Signs and symptoms Hyperglycemia in stroke Patients may come to the attention of clinicians because of preexisting diabetes mellitus Diabetes may also be seen with other risk factors for stroke, such as hypertension and hypercholesterolemia High glycemic levels may also be seen in the setting of an acute stroke without a history of diabetes, presumably due to a sympathetic response to the infarct Retinopathy, neuropathy, and peripheral vascular disease may be found in patients with long-standing diabetes Hypoglycemia in strokelike occurrences In the literature, signs of an acute stroke, such as hemiplegia, aphasia, and cortical blindness, have been reported with hypoglycemia. In individuals presenting with low glycemic levels and strokelike symptoms, diabetes mellitus may have been previously diagnosed, and recent changes in the doses of hypoglycemic agents and insulin may have been instituted. In particular, aggressively tight glucose control, either patient driven or clinician directed, may give rise to chronic or recurrent episodes of hypoglycemia. However, if factitious hypoglycemia is suspected, such behavior may have manifested earlier as similar episodes or other factitious behaviors. Symptoms caused by hypoglycemia can occur suddenly and fluctuate, suggesting a vascular etiology. Diagnosis Laboratory studies In the settin Continue reading >>

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