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Cerebral Edema In Dka Medscape

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How to Present a Patient: Series for Medical Students Texas Tech University Health Sciences Center School of Medicine in Lubbock Ashley, 2 Weeks, Female

Pediatric Diabetic Ketoacidosisdifferential Diagnoses

Pediatric Diabetic KetoacidosisDifferential Diagnoses Author: William H Lamb, MD, MBBS, FRCP(Edin), FRCP, FRCPCH; Chief Editor: Timothy E Corden, MD more... Edge JA, Roy Y, Bergomi A, et al. Conscious level in children with diabetic ketoacidosis is related to severity of acidosis and not to blood glucose concentration. Pediatr Diabetes. 2006 Feb. 7(1):11-5. [Medline] . Harris GD, Fiordalisi I. Physiologic management of diabetic ketoacidemia. A 5-year prospective pediatric experience in 231 episodes. Arch Pediatr Adolesc Med. 1994 Oct. 148(10):1046-52. [Medline] . Wolfsdorf J, Craig ME, Daneman D, et al. Diabetic ketoacidosis. Pediatr Diabetes. 2007 Feb. 8(1):28-43. [Medline] . Marshall SM, Walker M, Alberti KGMM. Diabetic Ketoacidosis and Hyperglycaemic non-ketotic coma. Alberti, Zimmet, Defronzo eds. International Textbook of Diabetes Mellitus. 1997. 1215-30. Fagan MJ, Avner J, Khine H. Initial fluid resuscitation for patients with diabetic ketoacidosis: how dry are they?. Clin Pediatr (Phila). 2008 Nov. 47(9):851-5. [Medline] . Durr JA, Hoffman WH, Sklar AH, et al. Correlates of brain edema in uncontrolled IDDM. Diabetes. 1992 May. 41(5):627-32. [Medline] . Hale PM, Rezvani I, B Continue reading >>

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  1. MathWiz

    I wasn’t sure which section I should post this in, my strategy is what I call the 4–2–1 plan, I fast 2 day non consecutive days a week, eat a low carb but not calorie restricted diet 4 days a week to keep the fat burning benefits of ketosis going and then I give myself 1 day a week to indulge and eat whatever I want, usually a Saturday pasta dinner and wonderful dessert. I also walk 4 to 6 miles a day during the week and 10 to 12 miles on Saturday.
    Low Carb plans such as Atkins can be very effective for some people including me, many people who start a low carb diet experience get what’s called the “ketosis flu” or the “induction flu” in the first few days while the body is adapting to burning ketones instead of glucose.
    The basic symptoms are:
    – Headaches
    – Nausea
    – Upset stomach
    – Lack of mental clarity (brain fog)
    – Sleepiness
    – Fatigue
    It’s called the “ketosis flu” for a reason: you feel sick. I’ve gone through it and it wasn’t a pleasant experience. Fortunately it only lasted 2 days but then suddenly I woke up feeling much better, less hungry and my energy level was really high and consistent throughout the day!
    The first time I thought to myself: “What the heck am I doing? I feel like I’m going to die!” but I persevered and when it was over I didn’t regret a thing because what I had gained mentally and physically was 100% worth it.
    For those of you that are going through the ketosis flu, don’t give up! I know you feel like it’s never going to get better but stick with it and you´ll be so happy you did! I’m telling you, waking up refreshed for the first time in years, not getting the afternoon “blah” feeling and stuffing my face with carbs to try to boost my energy is the best side effect of the low carb diet I’ve experienced. Okay, losing weight while eating good food, feeling full and satisfied is great too.
    First you have to understand why your body is reacting this way. Your body’s been burning glucose for energy so it’s basically full of enzymes that are waiting to deal with the carbs you eat, but now the body needs to make new enzymes that burn fat for fuel instead of carbs, and the transition period causes the flu-like symptoms.
    There are some things you can do to lessen the symptoms of the ketosis flu and to make it go away sooner (to force the body to transition sooner) Ok, let’s get to the good part – what to do:
    First of all – you’re probably dehydrated. Drink PLENTY of water while you’re on a low carb diet, and then drink some more.
    Watch your electrolytes. When the body is getting rid of excess insulin from your former carb-crazy diet you´ll lose lots of fluids that have been retained in your body. This causes the rapid weight loss most people see in their first few days of ketosis, it’s mostly water, sorry. When you lose all the retained water you also lose electrolytes like sodium, magnesium and potassium. When you’re lacking them you´ll feel like crap so when you’re feeling really ill on the ketosis flu try things like chicken/beef broth and look for foods rich in these minerals. Take a multi-vitamin and a multi-mineral.
    Ok, here is where people throw the red flag – Eat more fat – Yup, I said MORE fat. Have some butter, just not on a roll, eat some bacon and eggs for breakfast, just skip the potatoes and toast. This will force your body to hurry up the transition. You´ll think this is crazy and think you´ll never get lose weight eating this way, but you will.
    Don’t eat too much protein – The body can transform protein into glucose so if you eat too much of it in the first days it will slow down the transition. Go for fatty meat and cheese if you can, add fat to protein shakes etc.
    Drink water, replenish electrolytes (sodium, magnesium, potassium) with food and supplements, drink broth, eat fat and not too much protein.
    I hope this helps, and have a great day
    Charles

  2. rockyromero

    @mathwiz
    ” Take a multi-vitamin and a multi-mineral.”
    I have been forgetting to take a multi-vitamin on fast days. Thanks for the reminder.
    “Eat more fat – Yup, I said MORE fat. ”
    I will have avocado more often.

  3. AussieJess

    Thanks for that info, very interesting

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Pediatric Dka Management In The Era Of Standardization

Seattle Children's Hospital, Division of Endocrinology and Diabetes, 4800 Sand Point Way NE, Seattle, WA 98105, USA. Financial & competing interests disclosure The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. No writing assistance was utilized in the production of this manuscript. Tel.: +1 206 987 5037 Fax: +1 206 987 2720 [email protected] Almost all episodes of diabetic ketoacidosis (DKA) are preventable The overall incidence of Type 1 diabetes mellitus has been rising, particularly in young children. Thus, there is a need for heightened awareness of DKA, a life-threatening complication of diabetes mellitus. Pediatric DKA is ideally managed at facilities that are familiar with its therapy and have availability of intense monitoring. Appropriate early management of DKA is crucial in preventing cerebral edema, the major cause of morbidity and mortality Continue reading >>

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  1. kryptomancer

    Experienced fasters: How long does it take you to reach ketosis?

    It seems that it takes about 3 days for the average person to get into a state of ketosis when fasting.
    For those of you who are veterans of fasting, especially longer fasts (5+ days), how long does it take you to get into ketosis?
    I'm curious about this due to this guy going into ketosis in only 2 days on his second 5 day fast. Was wondering if it was due to the avocado or his body just adapting faster.

  2. Glarsie

    You should be in ketosis once your liver glycogen stores are depleted. In a fast this should occur in 24-48hrs after your last meal and will be influenced by your insulin sensitivity (which affects you basal insulin level) and the amount of glycogen in your liver (ie what you ate leading up to the fast). It's entirely possible (some would argue desirable) to be in ketosis before fasting. Nutritional ketosis generally starts when you have a betahydroxybuterate level greater than .5 mmol/L which can't be accurately measured through urine ketostix which only show excreted acetoacetate (not blood concentrations of BHB). You can turn those keto sticks dark purple just by restricting fluid intake and becoming slightly dehydrated or equally make them not register by drinking half a gallon of water.
    Ketosis is brought on by a lack of carbohydrates/insulin and not by the presence of fat.
    Eat under 20g of net carbs per day (don't count fibre) for 3 days and you will be in ketosis. You will probably be in ketosis sooner, but 3 days is pretty true for everyone.
    Remember that as you produce ketones you will start to use them as well as free fatty acids for fuel (less is excreted in urine and blood levels don't increase indefinitely). In the end ketones will be used primarily for your brain and other tissues not able to use FFA while glucose will be reserved for cells that can only use glucose (eg red blood cells and some parts of the brain). The breakdown of triglycerides into FFAs also releases glycerol that is converted into glucose to supply the now reduced demand for glucose. This doesn't happen as soon as you produce ketones but over a few days as your levels increase.
    Edit: nutritional ketosis defined as starting at .5 rather than .3 mmol/l

  3. kryptomancer

    this should occur in 24-48hrs after your last meal
    Actually in the link I posted it took 3 days initially for the guy to go into ketosis, then on the second time through it only took him 2. I'm very interested in to why this was as I am planning on doing a series of longer fasts and want to make it as easy as possible.
    and will be influenced by your insulin sensitivity
    So perhaps the reason why the 2nd fast was quicker to get into ketosis with due to increased insulin sensitivity from his initial fast?
    and the amount of glycogen in your liver (ie what you ate leading up to the fast).
    This is my current plan: eat under 20g carbs for two days, start water fasting on the third and lifting heavy squats and dead lifts; then taking apple cider vinegar before bed.

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Myke Federman, MD, provides an update on current guidelines for management of pediatric sepsis. Premiere Date: 10/23/2015; minutes, seconds Learn more at https://uclahealth.org/Mattel

Pediatric Diabetic Ketoacidosisworkup

Author: William H Lamb, MD, MBBS, FRCP(Edin), FRCP, FRCPCH; Chief Editor: Timothy E Corden, MD more... The following lab studies are indicated in patients with diabetic ketoacidosis: Bicarbonate - Usually available from blood gas analysis Perform head computed tomography (CT) scanning if coma is present or develops. Concurrently, initiate appropriate measures to manage cerebral edema. Perform chest radiography if clinically indicated. Check the patients consciousness level hourly for up to 12 hours, especially in a young child with a first presentation of diabetes. The Glasgow coma scale (see the image below) is recommended for this purpose. Glasgow Coma Scale, modified for age of verbal response. The normal maximum score on the Glasgow coma scale is 15. A score of 12 or less implies significant impairment of consciousness. A falling score may signify the development of cerebral edema. Capillary blood samples analyzed on any modern blood glucose meter are acceptable for monitoring changes in blood glucose levels as treatment progresses, but measure at least 1 whole blood glucose at presentation. Check blood glucose at least hourly during the initial stages of treatment (more frequ Continue reading >>

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  1. itsryanneyo

    So after a month of horrible stomach pains, I finally went to see my alternative medicine doctor. My gallbladder is sludgy and full of pebbles, and she's put me on a pretty good dose of hydrangea root to break up the stones and hi-lipase to get everything flushed out of my g.b... I've read so many different versions of what causes this--eating high fat / eating low fat / eating low fat and then going to high fat. I'm not too terribly wrapped up in what caused it, but rather getting it taken care of. I still battle the constipation that everyone else seems to get past after the first 4 weeks, and I'm sure that this has contributed to my g.b. issues. Anyone else had to deal with this? My results and every other aspect of my well-being are so great, I can't fathom not being on a LC lifestyle. I love my bulletproof coffee, but even sometimes just a few sips is now sending my gut into the ultimate knot. I haven't let this issue keep me from working out, still going strong 6 days a week, but not sure how much longer I'm gonna be able to keep that up...
    Any words of advice would be greatly appreciated!

  2. ejdp254

    Sorry no answer for you, my gall stones acted up after about 5 month's, absolute agony, I can eat normally now but my gall bladder is also full of sludge and stones so waiting for my Dr to suggest a solution - hopefully without surgery! That said I already had gall stones so I doubt if 5 months LCHF made that much difference and I hope to continue eating this way

  3. itsryanneyo

    Our stories sound so similar! I was 5 months in when my gut started hurting, as well... I did read that if you ate low carb and/or high protein that makes them develop, and then act up when you start loading up on fats. Not sure about you, but that's definitely my story... I was really big into low fat, high protein prior to keto. Please let me know if you have any luck, I'm open to suggestions...

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