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Can You Get Brain Damage From Ketoacidosis?

Original Articles Regional Brain Water Content And Distribution During Diabetic Ketoacidosis

Original Articles Regional Brain Water Content And Distribution During Diabetic Ketoacidosis

To characterize regional differences in brain water distribution and content during diabetic ketoacidosis (DKA) in children and determine whether these differences correlate with regional vascular supply. We compared changes in brain water distribution and water content in different brain regions during DKA by analyzing magnetic resonance diffusion weighted imaging data collected during DKA and after recovery in 45 children (<18 years of age). We measured the apparent diffusion coefficient (ADC) of water in the frontal and occipital cortex, basal ganglia, thalamus, hippocampus, and medulla. Brain water content was also measured in a subset of patients. ADC values were elevated (suggesting vasogenic cerebral edema) in the frontal cortex, basal ganglia, thalamus, and hippocampus during DKA. In contrast, ADC values in the medulla and the occipital cortex were not increased during DKA, and ADC changes in the medulla tended to be negatively correlated with other regions. Regions supplied by the anterior/middle cerebral artery circulation had greater elevations in both ADC and brain water content during DKA compared with regions supplied by the posterior cerebral artery circulation. ADC changes during DKA in the brainstem contrast with those of other brain regions, and changes in both ADC and brain water content during DKA vary according to regional vascular supply. These data suggest that brainstem blood flow might possibly be reduced during DKA concurrent with hyperemia in other brain regions. Continue reading >>

Biomarkers And Genetics Of Brain Injury Risk In Diabetic Ketoacidosis: A Pilot Study

Biomarkers And Genetics Of Brain Injury Risk In Diabetic Ketoacidosis: A Pilot Study

Go to: 1. Introduction Diabetic ketoacidosis (DKA) complicated by cerebral edema was first identified and described in 1936, and it remains the most common and catastrophic presentation of previously undiagnosed or poorly controlled type 1 diabetes mellitus (T1DM) in children [1]. Cerebral dysfunction is common in DKA, with overt cerebral edema being the most devastating form of cerebral injury in DKA (CIDKA). Cerebral edema occurs overtly in approximately 0.5 to 1% of DKA cases. Although infrequent, cerebral edema accounts for a large proportion of the deaths (24–90%) in pediatric patients with DKA, and 20% of all pediatric deaths attributable to diabetes in general [2–13]. Even among patients without clinically overt cerebral edema, a large percentage of DKA patients exhibit some form of central nervous system injury or dysfunction manifested as depressed mental status, headache, dizziness, and/or weakness [3–5, 14]. Glaser et al. [7, 8] suggested that “subclinical cerebral edema” may be present in over half of all children being treated for DKA. A study performed at Children’s Hospital and Research Center Oakland revealed that of 304 patients treated for DKA, 42 (13.8%) had clinical evidence of some level of cerebral dysfunction and/or injury [14]. In addition, Ghetti et al. [5] and other investigators have shown that, even without overt evidence of cerebral edema, overall cognitive function, specifically memory, is affected by as few as one episode of DKA[2, 14, 15]. Although morbidity and mortality are high in overt cerebral edema, the long-term effects of this less severe presentation are not fully understood. Some studies indicate that one third of survivors of CIDKA will have significant long-term disability [3, 4, 16–20]. However, most information Continue reading >>

Complications Of Diabetic Ketoacidosis (dka) And Septic Shock

Complications Of Diabetic Ketoacidosis (dka) And Septic Shock

Hi Dr T, A few weeks ago a family member of mine in her late 60’s who is a brittle diabetic was found unconscious at her home, while sitting up with feet colored white and purple. Blood sugar over 600 but she was responsive and coherent twenty four hours before. The family doctor thought it was due to pneumonia that would cause her blood sugar too spike. All of a sudden normal breathing stopped and cpr was performed. within like 20 seconds and ambulance called, they were there within 3 minutes. It took paramedica a few minutes to get a pulse and she went into the ICU. If there is brain damage would it have made a difference if she was in the er instead of at home or does septic shock just hit suddenly and unexpectedly? Does septic shock just suddenly cause bp to drop and heart to stop? Even with cpr if the hear stops is the brain deprived until it starts on its own? ———- FOLLOW-UP ———- QUESTION: Can DKA cause a heart to stop immediately say withing 90 of a good BP? Also can Septic shock cause a heart to just stop with an unexcptected quick nosedive in BP, say over 10 minutes These are questions for the ICU docs to answer. Infections as well as other medical conditions can cause diabetes to derail (like in her case) and cause a coma. Associated heart problems can be uncovered during such an episode. I have no way of telling whether severe brain damage occurred. Hope this helps, Dr T Follow-up Answer: Diabetic ketoacidosis (DKA) is a potentially life-threatening complication in patients with diabetes mellitus. In some circumstances it may cause a diabetic coma and severe dehydration. If dehydration is so severe, shock (severely decreased blood pressure with insufficient blood supply to the body’s organs) may be the result. If not treated quickly, it may be Continue reading >>

Effects Of Diabetes

Effects Of Diabetes

In some cases the effects may be short term and can be eliminated through appropriate treatment. In the case of long term complications, any damage sustained tends to be permanent. Whilst there are a lot of ways in which diabetes can affect the body, it’s important to note that the risks of developing health problems can be significantly reduced through good management of diabetes and living a healthy life. Heart Higher than normal blood sugar levels over a period of time can lead to an increase in risk of damage occurring to larger blood vessels in the body. This raises the risk of blood clots forming in blood vessels which can lead to heart attacks – a form of coronary heart disease. Approximately, 600,000 people die of heart disease in the United States every year–that’s 1 in every 4 deaths. Learn more about Heart disease. Brain The brain is another major organ that can pose a threat to life if it is affected by damage or blockages in its blood supply. Elevated blood sugar levels over a long period of time can cause blockages in the blood vessels supplying the brain, resulting in stroke, and can also damage the very small blood vessels in the outer part of the brain, increasing the risk of brain damage and conditions such as Alzheimer’s disease. In the short term, too low blood glucose levels can lead to a reduced ability to make decisions and cause confusion and disorientation. Nerves The nerves play a very important part throughout the body. Not only do they allow us to sense touch, nerves also allow our organs to function properly. For instance, nerves are crucial in helping the digestive system to sense how it should respond. If the nerves become damaged we can lose our ability to sense pain in parts of the body that are affected and if nerve damage (ne Continue reading >>

Side Effects Of Sglt2 Inhibitors

Side Effects Of Sglt2 Inhibitors

SGLT2 Inhibitors SGLT2 inhibitors work by acting on the kidneys. SGLT2 inhibitors have also been linked with multiple kidney-related problems such as renal impairment and acute kidney injury. Serious urinary tract infections that can affect the kidneys, known as pyelonephritis, or cause blood infections, known as urosepsis, are also potential side effects. Brand names of SGLT2 inhibitors include Invokana, Invokamet, Farxiga, Glyxambi, Jardiance, Xigduo XR and Synjardy. Each of these medications has been associated with health risks. Some people who have suffered the side effects of SGLT2 inhibitors have sought legal compensation. Diabetic Ketoacidosis As well as causing problems with kidneys, the U.S. Food and Drug Administration (FDA) warned in a May 2015 Safety Announcement that SGLT2 inhibitors may result in a serious condition known as diabetic ketoacidosis. Usually, this condition can occur when a diabetic’s blood-sugar levels dip below a normal range, indicating that the body does not have enough glucose (or blood sugar), the body’s preferred sustenance. When the body lacks glucose, the body instead uses fat for fuel. The process of burning fat to fuel the body can produce a large amount of ketones, which are blood acids that can poison the body in excessive amounts. This state of excessive ketones in the body is diabetic ketoacidosis. When diabetic ketoacidosis occurs, the sufferer can fall into a diabetic coma. The effects of ketoacidosis can be lethal if the condition is not promptly addressed. The FDA has advised that patients should “stop taking their SGLT2 inhibitor and seek medical attention immediately if they have any symptoms of ketoacidosis. …” Treatment of ketoacidosis usually requires hospitalization. Normally, diabetic ketoacidosis is broug Continue reading >>

Are People With Diabetes More Prone To Aggression?

Are People With Diabetes More Prone To Aggression?

Relationship Between Blood Glucose Level and Self-Control Blood sugar can make people do crazy things. According to a recent scientific study on the link between low blood glucose level and relationship clashes (Bushman et al, 2014), being hungry makes an individual generally cranky and act more hostile to others. In the study, couples who are hungry tend to have a much higher tendency to exhibit aggression towards each other and become more impulsive in their reactions. This phenomenon is often referred to “hangry” (meaning feeling angry when you are hungry). If this irritable state can happen to any healthy person who experiences a change in their blood glucose level, imagine the ordeals individuals with diabetes frequently go through on a daily basis. However, do not jump to the conclusion that diabetes leads to aggression. In fact, scientists find a more direct correlation between blood glucose level and self-control. I recommend reading the following articles: In a way, you can visualize self-control as a muscle that requires a lot of energy to sustain so that it does not become ineffective quickly. This energy source comes from the glucose in the blood. So what kind of activities can wear out this “muscle”? Any daily activities that require self-discipline such as forcing yourself to get out of bed early to exercise, resisting from having a soda drink or another cookie with your meal, stopping yourself from smoking, dealing with stressful situations at work and at home, and abstaining yourself from road rage. As you can see, self-control plays a crucial part in restraining inappropriate and aggressive behaviors. So when people are low in glucose, the self-control mechanism cannot function properly to prevent these outbursts of hostile actions. In a researc Continue reading >>

Is The Brain Affected In Diabetes Mellitus?

Is The Brain Affected In Diabetes Mellitus?

Didi....This is a very good question because the impact of diabetes on the brain is actually overlooked. Theoretically, one can say that since diabetes affects so many organs in the body, therefore, it might affect the brain as well. Practically speaking, it has been shown that chronic hyperglycemia leads to the release of mediators that cause chronic brain inflammation, reduce blood flow and damage the cells. In fact hyperglycemia raises the risk of having dementia and depression. The chances of becoming depressed or getting dementia increases when diabetes complications develop and decreases in diabetic people with good blood sugar control. Besides, cardiovascular complications could contribute to stroke by blocking the blood flow to the brain. Another way in which diabetes can affect the brain is ketoacidosis, that occurs most likely in Type I diabetes, where the brain cannot handle the excessive amounts of ketone bodies. We must not forget that hypoglycemia, resulting from an overdose of antidiabetic drugs, leads to hypoglycemic coma. Continue reading >>

Cerebral Edema In Diabetic Ketoacidosis: A Look Beyond Rehydration

Cerebral Edema In Diabetic Ketoacidosis: A Look Beyond Rehydration

The Journal of Clinical Endocrinology & Metabolism Cerebral Edema in Diabetic Ketoacidosis: A Look Beyond Rehydration Department of Pediatrics University of Florida Gainesville, Florida 32610 Search for other works by this author on: The Journal of Clinical Endocrinology & Metabolism, Volume 85, Issue 2, 1 February 2000, Pages 509513, Andrew Muir; Cerebral Edema in Diabetic Ketoacidosis: A Look Beyond Rehydration, The Journal of Clinical Endocrinology & Metabolism, Volume 85, Issue 2, 1 February 2000, Pages 509513, INJUDICIOUS fluid resuscitation is frequently suggested as the cause of the cerebral edema that is the most common cause of mortality among pediatric patients with diabetic ketoacidosis (DKA) ( 1 ). The evidence, however, supports the hypothesis that neurological demise in DKA is a multifactorial process that cannot be reliably prevented by cautious rehydration protocols. Mortality and severe morbidity can, however, be reduced when healthcare providers watch vigilantly for and respond rapidly to the sentinel neurological signs and symptoms that precede, often by hours, the dramatic collapse that is typically described in these patients. Children being treated for DKA develop clinically important neurological compromise about 0.21.0% of the time ( 2 ). Subclinical neurological pathology, causing raised intracranial pressure, likely precedes the initiation of therapy in almost all cases of DKA ( 3 5 ). Intracranial hypertension has been considered to be aggravated by therapy of the DKA ( 4 , 6 , 7 ), but in keeping with the physicians perplexity about the problem, even this widely held tenet has recently been challenged ( 8 ). The pathogenic mechanism for this terrifying complication remains unknown. Hypothetical causes of cerebral edema in children with DKA m Continue reading >>

Cerebral Edema In Children With Diabetic Ketoacidosis

Cerebral Edema In Children With Diabetic Ketoacidosis

INTRODUCTION Cerebral edema (or cerebral injury) is an uncommon but potentially devastating consequence of diabetic ketoacidosis (DKA). It is far more common among children with DKA than among adults. Young children and those with newly diagnosed diabetes are at highest risk. Symptoms typically emerge during treatment for DKA, but may be present prior to initiation of therapy. The pathophysiology, diagnosis, and treatment of cerebral edema in children with DKA will be discussed here. The diagnosis and treatment of DKA in children is discussed separately. (See "Clinical features and diagnosis of diabetic ketoacidosis in children and adolescents" and "Treatment and complications of diabetic ketoacidosis in children and adolescents".) INCIDENCE Clinically significant cerebral edema occurs in approximately 1 percent of episodes of DKA in children and has a mortality rate of 20 to 90 percent [1-3]. Overall mortality rates for diabetic ketoacidosis (DKA) in children and adolescents range from 0.15 to 0.51 percent in national population studies in Canada, the United Kingdom, and the United States [4-9]; 50 to 80 percent of diabetes-related deaths are caused by cerebral edema [1,2,10]. Other causes of death from DKA include aspiration pneumonia, multiple organ failure, gastric perforation, and traumatic hydrothorax [5]. Subclinical brain swelling, as detected by ventricular narrowing on a computed tomography (CT) scan, has been reported in the majority of children with DKA in some studies [11,12], while others reported much smaller proportions [13]. All of these studies were limited by small numbers and lack of appropriate control groups. In a study of 41 children with DKA, the intercaudate width of the frontal horns of the lateral ventricles was measured by magnetic resonance Continue reading >>

Cerebral Proton Magnetic Resonance Spectroscopy In Children With Diabetic Ketoacidosis

Cerebral Proton Magnetic Resonance Spectroscopy In Children With Diabetic Ketoacidosis

BACKGROUND AND PURPOSE: Subclinical cerebral edema occurs in many, if not most, children with diabetic ketoacidosis (DKA) and may be an indicator of subtle brain injury. Brain ratios of N-acetylaspartate (NAA) to creatine (Cr), measured by proton MR spectroscopy, decrease with neuronal injury or dysfunction. We hypothesized that brain NAA/Cr ratios may be decreased in children in DKA, indicating subtle neuronal injury. MATERIALS AND METHODS: Twenty-nine children with DKA underwent cerebral proton MR spectroscopy during DKA treatment (2–12 hours after initiating therapy) and after recovery from the episode (72 hours or more after the initiation of therapy). We measured peak heights of NAA, Cr, and choline (Cho) in 3 locations within the brain: the occipital gray matter, the basal ganglia, and periaqueductal gray matter. These regions were identified in previous studies as areas at greater risk for neurologic injury in DKA-related cerebral edema. We calculated the ratios of NAA/Cr and Cho/Cr and compared these ratios during the acute illness and recovery periods. RESULTS: In the basal ganglia, the ratio of NAA/Cr was significantly lower during DKA treatment compared with that after recovery (1.68 ± 0.24 versus 1.86 ± 0.28, P < .005). There was a trend toward lower NAA/Cr ratios during DKA treatment in the periaqueductal gray matter (1.66 ± 0.38 versus 1.91 ± 0.50, P = .06) and the occipital gray matter (1.97 ± 0.28 versus 2.13 ± 0.18, P = .08). In contrast, there were no significant changes in Cho/Cr ratios in any region. CONCLUSIONS: NAA/Cr ratios are decreased in children during DKA and improve after recovery. This finding suggests that during DKA neuronal function or viability or both are compromised and improve after treatment and recovery. Clinically apparent Continue reading >>

Diabetic Ketoacidosis (dka)

Diabetic Ketoacidosis (dka)

Tweet Diabetic ketoacidosis (DKA) is a dangerous complication faced by people with diabetes which happens when the body starts running out of insulin. DKA is most commonly associated with type 1 diabetes, however, people with type 2 diabetes that produce very little of their own insulin may also be affected. Ketoacidosis is a serious short term complication which can result in coma or even death if it is not treated quickly. Read about Diabetes and Ketones What is diabetic ketoacidosis? DKA occurs when the body has insufficient insulin to allow enough glucose to enter cells, and so the body switches to burning fatty acids and producing acidic ketone bodies. A high level of ketone bodies in the blood can cause particularly severe illness. Symptoms of DKA Diabetic ketoacidosis may itself be the symptom of undiagnosed type 1 diabetes. Typical symptoms of diabetic ketoacidosis include: Vomiting Dehydration An unusual smell on the breath –sometimes compared to the smell of pear drops Deep laboured breathing (called kussmaul breathing) or hyperventilation Rapid heartbeat Confusion and disorientation Symptoms of diabetic ketoacidosis usually evolve over a 24 hour period if blood glucose levels become and remain too high (hyperglycemia). Causes and risk factors for diabetic ketoacidosis As noted above, DKA is caused by the body having too little insulin to allow cells to take in glucose for energy. This may happen for a number of reasons including: Having blood glucose levels consistently over 15 mmol/l Missing insulin injections If a fault has developed in your insulin pen or insulin pump As a result of illness or infections High or prolonged levels of stress Excessive alcohol consumption DKA may also occur prior to a diagnosis of type 1 diabetes. Ketoacidosis can occasional Continue reading >>

Dka: Raising Awareness To Save Lives

Dka: Raising Awareness To Save Lives

WRITTEN BY: Sarah Lucas Recently there have been countless stories of US children lost to a disease neither their parents nor doctors even knew they had developed – Type 1 diabetes. Their early symptoms were missed or easily excused away and their more pronounced symptoms were mistaken for the flu or strep throat. By the time the true nature of their disease was discovered, their bodies, without the ability to produce insulin, had begun to burn fat for energy. The resulting molecules, ketones, essentially built up and poisoned their bodies, resulting in diabetic ketoacidosis, or DKA. For children like Kycie Jai Terry (5), David M Brown II (4), Angela Elizabeth Robinson (11) whose blood sugar at diagnosis was 1600, they never had the opportunity to “live beyond.” Their Type 1 diagnosis, like thousands of others, came too late. Their lives were cut short and their families devastated. An estimated 41% of individuals are in DKA at the diagnosis in the US, and that number varies in countries around the globe, from 12% to an astounding 80%. DKA costs families tens of millions of dollars each year in emergency care, carries the risk of permanent organ and brain damage, and is the leading cause of mortality in childhood diabetes. The majority of this devastation could be avoided. There is a safe, non-invasive, inexpensive (on average 24¢) way to safeguard lives and protect futures. A simple urine test or a finger prick for one drop of blood is all that is needed, but people have to know the warning signs and have to advocate for testing. When my daughter Mary was diagnosed, I was frightened for her and for our family – but a diagnosis meant that we were able to get her treatment, it meant that she was coming home from the hospital and that we would adjust, carry on an Continue reading >>

Alcoholic Ketoacidosis: Another Risk Of Chronic Alcohol Abuse

Alcoholic Ketoacidosis: Another Risk Of Chronic Alcohol Abuse

Alcoholic Ketoacidosis: Another Risk ofChronic Alcohol acts like poison within the human body. It enters the bloodstream and affects every part of the body, making the drinker vulnerable to serious health consequences. Chronic alcohol abuse exposes the central nervous, digestive, circulatory, immune, skeletal, and muscle systems to severe and long-lasting damage. Alcoholic ketoacidosis (AKA) is a disease that develops from drinking too much alcohol. Learn about this harmful condition and what you can do to prevent it. Alcoholic ketoacidosis occurs when there is an unhealthy buildup of ketones in the body. Ketones are a byproduct of the body burning fat instead of glucose for energy. Cells need glucose and insulin to function properly. The pancreas produces insulin, and glucose comes from the foods you eat. Consuming too much alcohol regularly, combined with a poor diet, can lead to the pancreas failing to produce insulin for a short time. This leads to your body burning fat for energy instead of using the glucose you consume. Without the production of insulin, ketones build up in the bloodstream, causing the life-threatening condition of AKA. Ketoacidosis occurs when the body digests something that gets turned into acid. Alcoholic ketoacidosis happens when excessive amounts of alcohol cause digestive problems. Failure to follow a holistic approach , such as eating a balanced diet, combined with excessive drinking and/or vomiting, leads to blood that is too acidic. Alcoholic ketoacidosis can be fatal, and requires treatment right away. Knowing how to identify AKA will help you recognize this condition in yourself or loved ones early on, giving you the best chance of recovery. This condition is treatable, but only with swift action to stop excessive alcohol consumption, Continue reading >>

How Does Type 1 Diabetes Affect Your Brain?

How Does Type 1 Diabetes Affect Your Brain?

Many tools and tips can help you control your type 1 diabetes. But left unchecked, it can affect several organs, including your brain. Big spikes and dips in blood sugar levels are linked to depression, shortened attention spans, and slowed reaction times, both physically and mentally. More research needs to be done for experts to figure out the exact short-term and long-term effects of diabetes on the brain -- but they're hopeful that they’ll find ways to prevent and even reverse damage. A 2014 study published by the American Diabetes Association shows that really high blood sugar (hyperglycemia) can slow the growth of a brain as it develops. The same is true when a child’s levels swing up and down a lot. Brain scans show differences between a child with diabetes and one without. Still researchers found no major differences in their IQs, mood, behavior, and learning and memory skills. It’s still unknown if the disease can affect things like their muscle movements and how fast they process information. Adults who’ve had type 1 for a long time have slower physical and mental reactions. The condition doesn’t seem to impact a person’s learning and thinking skills, researchers say. But memory and attention span can be affected. Type 1, like type 2, is linked with a high rate of depression. High blood sugar levels and the stress of managing a long-term disease are to blame. The best defense is to control your blood sugar, eat a healthy diet, and follow all of your doctor’s instructions. The longer your levels stay really high or low, or swing to extremes, the more likely your brain will be affected. Continuous glucose monitors are a great tool, since they measure blood sugar every 5 minutes. Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

What is Diabetic Ketoacidosis Diabetic ketoacidosis (DKA) is the hallmark of type 1 (insulin-dependent) diabetes mellitus. DKA is an emergency condition caused by a disturbance in your body’s metabolism. Extremely high blood glucose levels, along with a severe lack of insulin, result in the breakdown of body fat for energy and an accumulation of ketones in the blood and urine. Statistics on Diabetic Ketoacidosis Diabetic ketoacidosis can occur in between 16%-80% of children presenting with newly diagnosed diabetes. It remains the most common cause of death for young type 1 diabetes sufferers. Before the discovery of insulin, mortality rates were up to 100%. Today, the mortality has fallen to around 2% due to early identification and treatment. Death is usually caused by cerebral oedema (swelling of the brain). DKA is most common in type 1 diabetes sufferers but may also occur in those with type 2 diabetes mellitus. However, the latter group usually has at least some functioning insulin so suffer from another disorder called hyperosmolar non-ketotic coma (HONK). DKA tends to occur in individuals younger than 19 years, the more brittle of type 1 diabetic patients. However, DKA can affect diabetic patients of any age or sex. Risk Factors for Diabetic Ketoacidosis People with diabetes lack sufficient insulin, a hormone the body uses to metabolise glucose (a simple sugar) for energy. Therefore in diabetic patients glucose is not available as a fuel, so the body turns to fat stores for energy. However when fats are broken down they produce byproducts called ketones which build up in the blood and can be damaging to the body. In particular, accumulated ketones can “spill” over into the urine and make the blood become more acidic than body tissues (ketoacidosis). Blood gl Continue reading >>

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