Cerebral Edema In Dka Medscape

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

Diabetic Ketoacidosis

Author: Osama Hamdy, MD, PhD; Chief Editor: Romesh Khardori, MD, PhD, FACP more... Diabetic ketoacidosis (DKA) is an acute, major, life-threatening complication of diabetes that mainly occurs in patients with type 1 diabetes, but it is not uncommon in some patients with type 2 diabetes. This condition is a complex disordered metabolic state characterized by hyperglycemia, ketoacidosis, and ketonuria. The most common early symptoms of DKA are the insidious increase in polydipsia and polyuria. The following are other signs and symptoms of DKA: Malaise, generalized weakness, and fatigability Nausea and vomiting; may be associated with diffuse abdominal pain, decreased appetite, and anorexia Rapid weight loss in patients newly diagnosed with type 1 diabetes History of failure to comply with insulin therapy or missed insulin injections due to vomiting or psychological reasons or history of mechanical failure of insulin infusion pump Altered consciousness (eg, mild disorientation, confusion); frank coma is uncommon but may occur when the condition is neglected or with severe dehydration/acidosis Signs and symptoms of DKA associated with possible intercurrent infection are as follows: Gl Continue reading >>

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  1. Elizabeth6

    This is going to be a long blog post… but I woke up today feeling like I had to write it because I see so many people not understand the subject. And it’s important for people with diabetes — and parents of children with type 1 diabetes especially — to know what’s going on when ketones are present.
    I see a lot of parents saying that high blood sugars and ketones go hand in hand, and that if you let your child’s blood sugar get high, they will have ketones. This is actually not true. So what I want to accomplish with this post is to clear up a few misunderstandings when it comes to what’s happening when your child (or you, if the person with diabetes = the person in the mirror) shows ketones. You’ll have to forgive me for saying “your child” a lot in this post because I’m a parent of a CWD and I’m going to talk as if this is about parenting, but it goes for people who are caring for their own diabetes as well, naturally.
    First, some background on me: I’m a science/medical editor, and I review and research a wide range of topics. Diabetes, of course, is required reading, but I do a lot in cardiology, renal medicine (kidneys), oncology (cancer medicine), and pediatrics. So I know a great deal more than your average Joe or Jane, but I wouldn’t call myself an expert. An advanced beginner, maybe. I have, however, worked with a lot of experts — the most notable being my son’s endocrinologist, who heads a clinic that treats not only kids with type 1 diabetes but kids with adrenal disorders and cystic fibrosis. He and I, plus a Nurse Practitioner/CDE on his clinic’s staff, wrote this book
    5 together … and it was in the course of this project that I learned what I know about ketones.
    A mini lesson in metabolism and physiology
    Some of this may be familiar territory, but please take a minute to read through it anyway so we’re on the same page.
    We all know (hopefully) that insulin’s job is to open the door to a cell to let glucose inside so the glucose can be used to fuel the cell. And of course, we all know that type 1 diabetes = no insulin (or not enough) to accomplish this task — don’t feel left out, type 2s, I’ll get to you in a minute! What I sense many of us don’t know is where the ketones come from, and that’s key to understanding what’s happening and how to fix it.
    In diabetes, we're conditioned to think "ketones = bad" but they actually are part of a normal bodily function. (It's just that, in diabetes, many normal functions are off kilter because good old insulin is central to everything!) In a person without diabetes who is burning glucose in their cells the usual way, there are times they need more glucose than is circulating currently in their blood to keep up the level of activity or energy use they have going on. So they eat food with carbohydrates (or fats), their pancreas pumps out insulin, the food is broken down into glucose, the insulin transfers that glucose into the cells, and viola, cells have glucose to use for energy.
    But if the person doesn’t eat — they're too sick to eat, they're sleeping, or they just don't have the ability to eat right now — they can still get glucose one of two ways. First, their liver can release glycogen, which is stored sugar, directly into the blood — quick, but limited; it’s usually used by the body to keep blood glucose levels consistent while we’re sleeping. The other method is (and I’m going to gloss over a lot of the details here), the liver releases chemical signals that tell the body to convert fats into glucose. And the conversion of fatty acids into glucose is what produces ketone bodies or ketones. They are basically a waste product of the “fat burning” conversion process.
    The thing is, this process exists for a reason. When food is available, you don’t need to break down body fat for glucose unless you’re doing a lot more work than the glucose in the food you eat can support. But when food isn’t available, “burning fats” is a great backup to keep your body, and especially your brain, supplied with energy. This is why ketones are considered a sign of “starvation” — they only appear when the body lacks energy from food. And in small amounts, they’re harmless. It’s normal, for instance, for a person to produce ketones if they're on a weight loss program that is based around exercise and calorie restrictions, because that’s kind of the whole goal — to induce your body to use up the glucose stored in fat because you need more energy (glucose) than you take in via food.
    This is where the "acid" part comes in
    The one drawback is that ketones are acids, and we humans have a fairly limited tolerance of acidity in our blood and tissues. If ketones accumulate in the body to a point of reducing our bodily pH past the minimum tolerated level of 7.35, we get sick — metabolic acidosis develops, which, if it’s caused by diabetes-related ketones, is known as diabetic ketoacidosis or DKA. When this happens, we have to start using up all sorts of stored minerals (calcium, potassium) to “buffer” the acids and get us back into the range our body likes (pH over 7.35 but below 7.45), and we also use up a lot of fluids because the only way to remove the excess acids is to process them through the urine. Dehydration and electrolyte imbalance are the immediate result; if it’s not corrected quickly, many other serious and life-threatening problems happen down the line.
    Luckily for those of us without diabetes, and for the most part for those with type 2 diabetes, the body has a solution to prevent ketone/acid accumulation, too: the glucose released into the blood by “fat burning” triggers a release of insulin, and insulin in even small amounts stops the signal to convert fat to glucose because it enables the cells to have the fuel they need. The ketones produced by the temporary period of starvation get peed out, and off we go on our way.
    But, as you know, people with type 1 diabetes can’t produce adequate insulin to meet their needs. Even people with type 2 diabetes who are capable of producing insulin may not be able to produce enough insulin to halt ketone production, because there has to be enough insulin present so that most of the body's cells get glucose and stop yelling to the liver that they're starving — and if you're very insulin-resistant, the amount needed may be more than your pancreas can put out (particularly since stress hormones increase insulin resistance). This is why a type 2 diabetic who is under severe physical stress, like an illness, can develop DKA, contrary to popular wisdom that DKA only happens in T1s.
    In either case, T1 or stressed/sick T2, without putting artificial insulin into the system, there is no way to stop the “burn fats” signal — and thus, ketones accumulate and produce ketoacidosis.
    The connection between ketones and high blood sugar
    Now, obviously, if the body is burning fatty acids and producing ketones, it’s also producing glucose. That’s kind of the point, right? And if there’s no insulin, the glucose isn’t getting used, and the cells are still “starving” even though there’s glucose coming out your eyeballs at this point — that’s only a slight exaggeration, by the way — you get accumulation of glucose along with the accumulation of ketones. High ketones = high glucose, in this situation.
    But that’s not always the case. If you’ve ever had a T1 child or other PWD with a stomach virus, you know what I mean — the blood sugar is low because no food is going in, so you have to cut back the insulin to prevent catastrophe because the kid can’t eat anything, but the ketones are high because, obviously, body still needs energy to fight off the illness and so it’s burning fats — yet the three things needed to cushion against DKA (fluids, electrolytes, insulin) can’t be used without making the kid yack and/or go low.
    As I mentioned earlier, it takes a very small amount of insulin to put a stop to ketone production — a lot less than it takes to move high concentrations of glucose out of the blood and into the cells. And ketones start up when cells can't get enough glucose from the blood — which can be either not enough insulin or not enough glucose present, or both at the same time. That means that you can have ketones without high blood sugar or vice versa. In other words: high blood sugar doesn’t cause ketones or DKA. You can have ketone production leading to DKA with either high or low blood sugar, depending on the situation. Remember, ketones come about because cells aren't getting glucose, not because the glucose is missing but because the insulin isn't there. Ketones are produced because of a lack of insulin to move the glucose into cells, not because of the excess of blood glucose.
    This means that if your type 1 diabetic is getting some insulin — my endo said the amount is equivalent to 10% of what the body actually needs — he or she won’t start or keep burning fats and generating ketones, but may still have high blood sugar.
    High blood sugar can happen even when there’s insulin available for a lot of reasons with nothing to do with ketones:
    If you eat more carbs than you bolused for, then obviously your BG will be high; you’ve taken in more glucose than you have insulin to move it, but you still have enough glucose moving into cells to prevent a starvation response.
    Stress hormones produce insulin resistance, which means even a correctly bolused meal makes your BG go high — and stress can be physical (you’re catching a cold and your body is fighting it off, for instance) or mental (tests at school, a fight with your spouse, parent, friend, or sibling, even a mass attack of Creepers in Minecraft… and YES, I HAVE SEEN THAT ONE.)
    Growth hormone in children also produces insulin resistance; a major cause of consistent highs in kids is growth spurts, and it’s why you get consistent highs at night in elementary-age kids and in early morning in teens.
    I’ve seen this in action before many times: my son will have sky-high BG because I’ve under-dosed or because the insulin flow from his pump is occluded (but not stopped completely), yet he has no ketones because he’s gotten/getting enough insulin to prevent the starvation response. This is also why type 2 diabetics don’t get DKA very often, because even when their blood sugars are sky high, they usually have enough insulin present to move enough glucose into cells to prevent fat burning, but not enough to overcome insulin resistance completely (but that’s a different metabolic issue altogether from what T1s have).
    Bottom line:
    So if you’re a parent whose child is showing high blood sugar and ketones, you’re looking at two problems resulting from one cause: You have ketone production because cells are still starving, regardless of how much glucose there is in the blood; and you have high blood sugar because there’s not enough insulin to move the glucose into cells to give them the energy they need. These problems have the same solution: give more insulin so the glucose goes where it's needed and the perceived need to provide more glucose by breaking down fats goes away.
    The reason I think it’s important to recognize this distinction is that I worry that parents may resist letting blood sugar get “too high” in a sick child who is showing ketones, thinking that keeping blood sugar lower will help avoid DKA, when in fact, when children are ill, it’s better to maintain blood sugar at higher levels so you can give enough insulin to avoid ketones and DKA. Given the two possibilities, working to avoid ketones is a much higher priority than striving for lower blood sugar.

    I hope this has been helpful.

  2. shoshana27

    I,ve learned a lot, thank you.

  3. Mari5

    Thanks for your explanation! I'm sure it can help many. The idea of 10% insulin being enough to keep from producing ketones is quite incredible. Of course, all depends on your diabetes, sickness, etc I understand that a person should look at the overall situation not just the fixed number.
    In YOUR experience, what level of ketones should a person feel concerned?

    I see your book was published in 2012 I'm sure lots of newly diagnosed parents would be interested in reading it. Is it mentioned on the site as a reference for newcomers? I don't know if that possible..... Congratulations on the book anyway!

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Diabetic Ketoacidosisdifferential Diagnoses

Diabetic KetoacidosisDifferential Diagnoses Author: Osama Hamdy, MD, PhD; Chief Editor: Romesh Khardori, MD, PhD, FACP more... In considering a diagnosis of diabetic ketoacidosis (DKA), the following indications should be taken into account: uremia, acute hypoglycemia coma, and catheter-related venous thrombosis, especially with femoral central venous catheters in children. Glaser NS, Marcin JP, Wootton-Gorges SL, et al. Correlation of clinical and biochemical findings with diabetic ketoacidosis-related cerebral edema in children using magnetic resonance diffusion-weighted imaging. J Pediatr. 2008 Jun 25. [Medline] . Umpierrez GE, Jones S, Smiley D, et al. Insulin analogs versus human insulin in the treatment of patients with diabetic ketoacidosis: a randomized controlled trial. Diabetes Care. 2009 Jul. 32(7):1164-9. [Medline] . [Full Text] . Herrington WG, Nye HJ, Hammersley MS, Watkinson PJ. Are arterial and venous samples clinically equivalent for the estimation of pH, serum bicarbonate and potassium concentration in critically ill patients?. Diabet Med. 2012 Jan. 29(1):32-5. [Medline] . Mrozik LT, Yung M. Hyperchloraemic metabolic acidosis slows recovery in children with diabe Continue reading >>

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Popular Questions

  1. ThePermMustWait

    I hope this isn't a controversial but I hope someone can share the science behind it. Lately on here and other sites I have been reading I'll see people write about their very strict keto diet that's also very low calorie. They exercise but they still plateau.
    I haven't gotten to that point because I'm only one month in and losing. Is it possible to eat so little that your body refuses to burn any more weight? How do certain items like artificial sweetners prevent weight loss when you still have large calorie deficit and perfect macros?
    I just worry I'll get to that point and give up.

  2. anbeav

    Nearly everyone who loses weight, keto or otherwise, hits a plateau, it's not a keto issue, it's a weight loss issue. NO, it's not starvation mode in that your body stops burning, but often the body pauses - you gain water in the place of lost fat and so the scale stays the same, if you are patient and keep with it eventually you whoosh the water. It's incredibly rare for sweeteners alone to stall weight loss, rather they cravings and hunger for some and they eat more. You will hit a stall, what does giving up do for you? Nothing. It gets you further from your goal. Accept that plateaus happen, count your calories accurately and be patient. Giving up doesn't help you, it's sabotage

  3. keto4life

    Good call on the water weight. It's also worth noting that the body weight can vary up to 2.5kg over a 48 hour period - so body weight alone is indeed a poor indicator in a short period of time. Often a "Plateau" is nothing more than a natural swing.

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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. Clare R

    Burned esophagus after DKA

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

  2. sandyfrazzini

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

  3. Clare R

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

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