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Clinical Manifestations Of Dka

Diabetic Emergencies – Diagnosis And Clinical Management: Diabetic Ketoacidosis In Adults

Diabetic Emergencies – Diagnosis And Clinical Management: Diabetic Ketoacidosis In Adults

Diabetic ketoacidosis (DKA) is an acute complication of diabetes mellitus. It is characterized by the triad of hyperglycemia, ketosis, and metabolic acidosis.1 DKA complicates mainly patients with Type 1 diabetes mellitus, where it may be the first manifestation of the disease, and rarely people with Type 2 diabetes.1 A special heterogeneous syndrome of "ketosis – prone diabetes (KPD)," in usually adult patients who may lack the typical clinical phenotype of autoimmune Type 1 diabetes, has recently been identified. While initially the condition was thought to be limited to persons of non-Caucasian ethnicity (African-Americans and Hispanics), its prevalence appears to be increasing worldwide.2 DKA is an emergency situation and hospitalization of the patient is necessary for immediate treatment. Its frequency is reported as 4.8 – 8.0 episodes per 1000 diabetic patients.3,4 The mortality rate is 2.5 – 9% and increases along with age, level of consciousness on admission, degree of hyperosmolality and acidosis, as well as severity of azotemia.5,6 In the US, hospitalizations due to DKA reach 100,000 and the cost of treatment has been reported as 1 billion dollars per year.7… The criteria for the diagnosis of DKA are shown in Table 1.1.8,9 DKA can be mild, moderate, or severe. It is considered severe when the arterial blood pH is less than 7.0, the concentration of plasma bicarbonate is less than 10 mEq/L, and the anion gap is greater than 12 mEq/L. In severe DKA, the patient is in stupor or in coma. Notably, the severity of DKA does not necessarily coincide with the degree of hyperglycemia. DKA can rarely be seen without marked hyperglycemia (euglycemic DKA), and in one series of 722 consecutive episodes of DKA only 1.1% had blood glucose levels less than 180 mg/dl (1 Continue reading >>

Diabetes Complications In Dogs And Cats: Diabetes Ketoacidosis (dka)

Diabetes Complications In Dogs And Cats: Diabetes Ketoacidosis (dka)

Unfortunately, we veterinarians are seeing an increased prevalence of diabetes mellitus in dogs and cats. This is likely due to the growing prevalence of obesity (secondary to inactive lifestyle, a high carbohydrate diet, lack of exercise, etc.). So, if you just had a dog or cat diagnosed with diabetes mellitus, what do you do? First, we encourage you to take a look at these articles for an explanation of the disease: Diabetes Mellitus (Sugar Diabetes) in Dogs Once you have a basic understanding of diabetes mellitus (or if you already had one), this article will teach you about life-threatening complications that can occur as a result of the disease; specifically, I discuss a life-threatening condition called diabetes ketoacidosis (DKA) so that you know how to help prevent it! What is DKA? When diabetes goes undiagnosed, or when it is difficult to control or regulate, the complication of DKA can occur. DKA develops because the body is so lacking in insulin that the sugar can’t get into the cells -- resulting in cell starvation. Cell starvation causes the body to start breaking down fat in an attempt to provide energy (or a fuel source) to the body. Unfortunately, these fat breakdown products, called “ketones,” are also poisonous to the body. Symptoms of DKA Clinical signs of DKA include the following: Weakness Not moving (in cats, hanging out by the water bowl) Not eating to complete anorexia Large urinary clumps in the litter box (my guideline? If it’s bigger than a tennis ball, it’s abnormal) Weight loss (most commonly over the back), despite an overweight body condition Excessively dry or oily skin coat Abnormal breath (typically a sweet “ketotic” odor) In severe cases DKA can also result in more significant signs: Abnormal breathing pattern Jaundice Ab Continue reading >>

Diabetic Ketoacidosis - Symptoms

Diabetic Ketoacidosis - Symptoms

A A A Diabetic Ketoacidosis Diabetic ketoacidosis (DKA) results from dehydration during a state of relative insulin deficiency, associated with high blood levels of sugar level and organic acids called ketones. Diabetic ketoacidosis is associated with significant disturbances of the body's chemistry, which resolve with proper therapy. Diabetic ketoacidosis usually occurs in people with type 1 (juvenile) diabetes mellitus (T1DM), but diabetic ketoacidosis can develop in any person with diabetes. Since type 1 diabetes typically starts before age 25 years, diabetic ketoacidosis is most common in this age group, but it may occur at any age. Males and females are equally affected. Diabetic ketoacidosis occurs when a person with diabetes becomes dehydrated. As the body produces a stress response, hormones (unopposed by insulin due to the insulin deficiency) begin to break down muscle, fat, and liver cells into glucose (sugar) and fatty acids for use as fuel. These hormones include glucagon, growth hormone, and adrenaline. These fatty acids are converted to ketones by a process called oxidation. The body consumes its own muscle, fat, and liver cells for fuel. In diabetic ketoacidosis, the body shifts from its normal fed metabolism (using carbohydrates for fuel) to a fasting state (using fat for fuel). The resulting increase in blood sugar occurs, because insulin is unavailable to transport sugar into cells for future use. As blood sugar levels rise, the kidneys cannot retain the extra sugar, which is dumped into the urine, thereby increasing urination and causing dehydration. Commonly, about 10% of total body fluids are lost as the patient slips into diabetic ketoacidosis. Significant loss of potassium and other salts in the excessive urination is also common. The most common Continue reading >>

Diabetic Ketoacidosis Explained

Diabetic Ketoacidosis Explained

Twitter Summary: DKA - a major complication of #diabetes – we describe what it is, symptoms, who’s at risk, prevention + treatment! One of the most notorious complications of diabetes is diabetic ketoacidosis, or DKA. First described in the late 19th century, DKA represented something close to the ultimate diabetes emergency: In just 24 hours, people can experience an onset of severe symptoms, all leading to coma or death. But DKA also represents one of the great triumphs of the revolution in diabetes care over the last century. Before the discovery of insulin in 1920, DKA was almost invariably fatal, but the mortality rate for DKA dropped to below 30 percent within 10 years, and now fewer than 1 percent of those who develop DKA die from it, provided they get adequate care in time. Don’t skip over that last phrase, because it’s crucial: DKA is very treatable, but only as long as it’s diagnosed promptly and patients understand the risk. Table of Contents: What are the symptoms of DKA? Does DKA occur in both type 1 and type 2 diabetes? What Can Patients do to Prevent DKA? What is DKA? Insulin plays a critical role in the body’s functioning: it tells cells to absorb the glucose in the blood so that the body can use it for energy. When there’s no insulin to take that glucose out of the blood, high blood sugar (hyperglycemia) results. The body will also start burning fatty acids for energy, since it can’t get that energy from glucose. To make fatty acids usable for energy, the liver has to convert them into compounds known as ketones, and these ketones make the blood more acidic. DKA results when acid levels get too high in the blood. There are other issues too, as DKA also often leads to the overproduction and release of hormones like glucagon and adrenaline Continue reading >>

Understanding And Treating Diabetic Ketoacidosis

Understanding And Treating Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a serious metabolic disorder that can occur in animals with diabetes mellitus (DM).1,2 Veterinary technicians play an integral role in managing and treating patients with this life-threatening condition. In addition to recognizing the clinical signs of this disorder and evaluating the patient's response to therapy, technicians should understand how this disorder occurs. DM is caused by a relative or absolute lack of insulin production by the pancreatic b-cells or by inactivity or loss of insulin receptors, which are usually found on membranes of skeletal muscle, fat, and liver cells.1,3 In dogs and cats, DM is classified as either insulin-dependent (the body is unable to produce sufficient insulin) or non-insulin-dependent (the body produces insulin, but the tissues in the body are resistant to the insulin).4 Most dogs and cats that develop DKA have an insulin deficiency. Insulin has many functions, including the enhancement of glucose uptake by the cells for energy.1 Without insulin, the cells cannot access glucose, thereby causing them to undergo starvation.2 The unused glucose remains in the circulation, resulting in hyperglycemia. To provide cells with an alternative energy source, the body breaks down adipocytes, releasing free fatty acids (FFAs) into the bloodstream. The liver subsequently converts FFAs to triglycerides and ketone bodies. These ketone bodies (i.e., acetone, acetoacetic acid, b-hydroxybutyric acid) can be used as energy by the tissues when there is a lack of glucose or nutritional intake.1,2 The breakdown of fat, combined with the body's inability to use glucose, causes many pets with diabetes to present with weight loss, despite having a ravenous appetite. If diabetes is undiagnosed or uncontrolled, a series of metab Continue reading >>

Recurrent Dka For Whom The Bell Tolls

Recurrent Dka For Whom The Bell Tolls

Diabetic ketoacidosis (DKA) is the leading cause of death, morbidity and excessive health-care utilization and costs in patients with type 1 diabetes mellitus; DKA is common at initial diagnosis, but uncommon thereafter. A new study has determined the risk factors for multiple DKA episodes and their relationship to the risk of death. Get time limited or full article access on ReadCube. Wolfsdorf, J. et al. ISPAD Clinical Practice Consensus Guidelines 2014. Diabetic ketoacidosis and hyperglycemic hyperosmolar state. Pediatr. Diabetes 15 (Suppl. 20), 154179 (2014). Kamel, K. S. & Halperin, M. L. Acid-base problems in diabetic ketoacidosis. N. Engl. J. Med. 372, 546554 (2015). Gibb, F. W., Teoh, W. L., Graham, J. & Lockman, K. A. Risk of death following admission to a UK hospital with diabetic ketoacidosis. Diabetologia (2016). Dabalea, D. et al. Trends in the prevalence of ketoacidosis at diabetes diagnosis: the SEARCH for diabetes in youth study. Pediatrics 133, e938e945 (2014). Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

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

What Are The 3 P's Of Diabetes?

What Are The 3 P's Of Diabetes?

The 3 classic symptoms of diabetes mellitus are polyuria, polydipsia and polyphagia -- also known as the 3 P's. Polyuria, polydipsia and polyphagia are defined as an increase in urination, thirst and hunger, respectively. The presence of the 3 P’s is a good indication that your blood sugar may be too high. With type 1 diabetes (T1DM), these symptoms typically develop relatively quickly and are more obvious, often leading to diagnosis of the condition. With type 2 diabetes (T2DM), the 3 P's are often more subtle and develop more gradually. As a result, people with type 2 diabetes may overlook these symptoms, leading to a delay in diagnosis. Video of the Day The 3 P’s of diabetes are typically among the first symptoms to occur in T1DM, but they can occur with other conditions. Polyuria, or excessive urine production, can be identified by needing to urinate during the night, frequent bathroom trips or accidents in potty-trained children. Polydipsia, a consequence of polyuria, is characterized by excessive thirst. An increase in fluid intake due to polydipsia can also contribute to increased urination. Polyphagia is the term for excessive or increased hunger. It occurs with diabetes because blood sugar is fails to enter body tissues normally, leaving them short of fuel to produce energy. To compensate, fat and muscle are broken down and used for energy resulting in weight loss, lack of energy and fatigue, which are most often seen with T1DM. Signs of long-term high blood sugar, such as blurred vision and tingling or numbness in hands and feet, are more common at diagnosis with T2DM. High Blood Sugar and the 3 P's The 3 P's of diabetes all stem from high blood sugar levels. Blood sugar is normally filtered by the kidneys but then reabsorbed into the blood. When blood sug Continue reading >>

Type 1 Diabetes - Symptoms, Diagnosis, Treatment

Type 1 Diabetes - Symptoms, Diagnosis, Treatment

Southern Cross Medical Library Southern Cross Medical Library information is necessarily of a general nature. Always seek specific medical advice for treatment appropriate to you. For more articles go to the Medical Library index page. Diabetes is diagnosed when a person has too much glucose (sugar) in the blood, as a result of the body having insufficient insulin or resisting the effects of insulin. Type 1 diabetes is a life-long variation of the disease that typically takes hold in childhood or adolescence, and is the result of the body’s immune system destroying the pancreas where insulin is made. Symptoms of Type 1 diabetes can appear suddenly. The condition can cause serious health complications over time but can be managed with insulin replacement therapy and lifestyle changes. General information Diabetes mellitus (commonly referred to as diabetes) is a group of diseases characterised by high blood sugar levels over a prolonged period of time. This page deals with type 1 diabetes. Other diabetes variations include: Type 2 diabetes – associated with a person being overweight Gestational diabetes – where a mother cannot produce enough insulin during pregnancy Type 1 diabetes accounts for 5-8% of people with diabetes, while type 2 diabetes is much more common, accounting for 85–90% of diabetes cases. Type 1 diabetes used to be known as juvenile diabetes and most often occurs in childhood, but it can also develop in adults. The condition may affect around one in every 5000 New Zealanders under the age of 15. Type 1 diabetes is more common in New Zealand Europeans than other ethnic groups. Causes Although the exact cause of type 1 diabetes is unknown, it is generally considered to be an autoimmune condition in which the body's immune system mistakenly attacks 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. Your body needs a constant source of energy. When you have plenty of insulin, your body cells can get all the energy they need from glucose. If you don't have enough insulin in your blood, your liver is programmed to manufacture emergency fuels. These fuels, made from fat, are called ketones (or keto acids). In a pinch, ketones can give you energy. However, if your body stays dependent on ketones for energy for too long, you soon will become ill. Ketones are acidic chemicals that are toxic at high concentrations. In diabetic ketoacidosis, ketones build up in the blood, seriously altering the normal chemistry of the blood and interfering with the function of multiple organs. They make the blood acidic, which causes vomiting and abdominal pain. If the acid level of the blood becomes extreme, ketoacidosis can cause falling blood pressure, coma and death. Ketoacidosis is always accompanied by dehydration, which is caused by high Continue reading >>

Clinical Signs

Clinical Signs

Go to site For Pet Owners Clinical signs exhibited by diabetic cats reflect the underlying pathological mechanisms of the disease and aid diagnosis. Of course, laboratory tests are needed to confirm diagnosis (see Diagnosis and Management Overview). Three distinct clinical pictures may develop in cats suffering from diabetes mellitus: Uncomplicated diabetes Complicated by ketoacidosis Hyperosmolar syndrome Clinical signs of uncomplicated diabetes The 4 classic clinical signs of diabetes mellitus in cats include: Polyuria Polyphagia Polydipsia Increased susceptibility to infections (eg, urinary tract infections) Owners may also notice weight loss in affected cats. Signs of diabetes mellitus complicated by ketoacidosis If feline diabetes is undetected and left untreated, it will shorten a cat’s lifespan. A dangerous, sometimes fatal metabolic acidosis or diabetic ketoacidosis (DKA) may develop. In untreated diabetic cats, excessive ketones are produced, resulting in ketonuria and DKA accompanied by electrolyte imbalances. Ketoacidosis is a serious condition that can ultimately lead to an acidotic coma and death. In addition to the classic clinical signs of diabetes, cats affected by DKA may present with: Loss of appetite Lethargy and depression Vomiting Diarrhea Weakness Dehydration Dyspnea Collapse or coma Signs of hyperosmolar syndrome Hyperosmolar syndrome is an uncommon complication of untreated diabetes mellitus. In animals in which target tissue resistance to insulin plays a role in the disease, insulin levels can be elevated. In these cases, ketosis is suppressed and plasma glucose concentrations can become very high. Hyperosmolar syndrome represents an emergency situation. Affected cats will become progressively weaker, anorexic, lethargic, and drink less. Ultim Continue reading >>

Diabetic Ketoacidosis (dka)

Diabetic Ketoacidosis (dka)

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

Diabetic 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 >>

Diabetic Ketoacidosis Clinical Presentation

Diabetic Ketoacidosis Clinical Presentation

History Insidious increased thirst (ie, polydipsia) and urination (ie, polyuria) are the most common early symptoms of diabetic ketoacidosis (DKA). Malaise, generalized weakness, and fatigability also can present as symptoms of DKA. Nausea and vomiting usually occur and may be associated with diffuse abdominal pain, decreased appetite, and anorexia. A history of rapid weight loss is a symptom in patients who are newly diagnosed with type 1 diabetes. Patients may present with a history of failure to comply with insulin therapy or missed insulin injections due to vomiting or psychological reasons. Decreased perspiration is another possible symptom of DKA. Altered consciousness in the form of mild disorientation or confusion can occur. Although frank coma is uncommon, it may occur when the condition is neglected or if dehydration or acidosis is severe. Among the symptoms of DKA associated with possible intercurrent infection are fever, dysuria, coughing, malaise, chills, chest pain, shortness of breath, and arthralgia. Acute chest pain or palpitation may occur in association with myocardial infarction. Painless infarction is not uncommon in patients with diabetes and should always be suspected in elderly patients. A study by Crossen et al indicated that in children with type 1 diabetes, those who have had a recent emergency department visit and have undergone a long period without visiting an endocrinologist are more likely to develop DKA. The study included 5263 pediatric patients with type 1 diabetes. [15] Continue reading >>

Clinical Characteristics Of Diabetic Ketoacidosis In Children With Newly Diagnosed Type 1 Diabetes In Addis Ababa, Ethiopia: A Cross-sectional Study

Clinical Characteristics Of Diabetic Ketoacidosis In Children With Newly Diagnosed Type 1 Diabetes In Addis Ababa, Ethiopia: A Cross-sectional Study

Abstract Diabetic ketoacidosis (DKA) is one of the most serious acute complications of type 1 diabetes (T1D) and the leading cause of morbidity and mortality in children with T1D. This study was aimed at assessing the prevalence and associated factors of DKA in children with newly diagnosed T1D in Addis Ababa. Methods A hospital based cross-sectional study was conducted in selected hospitals in Addis Ababa. Children below the age of 12 years with DKA who were admitted to the pediatric ward in the selected hospitals between January 2009 and December 2014 and the residence of Addis Ababa were included. DKA was defined as children below the age of 12 years who have blood glucose level ≥250mg/dl, ketonuria, and ketonemia and diagnosed being T1D patient for the first time. Descriptive statistics was performed using frequency distribution, mean, median, tables, and graphs. Logistic regression analysis was used to identify independent factors associated with the prevalence of DKA in children with newly diagnosed T1D. Of 395 DKA patients who were hospitalized during the five-year period, 142(35.8%) presented with DKA at first diagnosis of diabetes. On the other hand 253 (64.2%) children with DKA had longstanding T1D. Independent factors associated with DKA include: Age category 2–4.49years, 7–9.49 years and ≥9.5years (Adjusted odd ratio (AOR) = 3.14[1.21,8.06]), 3.44(1.39,8.49) and 4.02(1.68,9.60), respectively); parents’ knowledge on the sign and symptoms of DKA (AOR = 0.51[0.27, 0.95]); sign and symptoms of DKA before the onset of DKA (AOR = 0.35[0.21, 0.59]) and infection prior to DKA onset (AOR = 3.45[1.97, 6.04]). The overall proportion of children diagnosed with DKA and new onset of T1D in Addis Ababa was high. In particular, children between 9–12 years of age Continue reading >>

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