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Clinical Manifestations Of Dka

> Hyperglycemia And Diabetic Ketoacidosis

> Hyperglycemia And Diabetic Ketoacidosis

When blood glucose levels (also called blood sugar levels) are too high, it's called hyperglycemia. Glucose is a sugar that comes from foods, and is formed and stored inside the body. It's the main source of energy for the body's cells and is carried to each through the bloodstream. But even though we need glucose for energy, too much glucose in the blood can be unhealthy. Hyperglycemia is the hallmark of diabetes — it happens when the body either can't make insulin (type 1 diabetes) or can't respond to insulin properly (type 2 diabetes). The body needs insulin so glucose in the blood can enter the cells to be used for energy. In people who have developed diabetes, glucose builds up in the blood, resulting in hyperglycemia. If it's not treated, hyperglycemia can cause serious health problems. Too much sugar in the bloodstream for long periods of time can damage the vessels that supply blood to vital organs. And, too much sugar in the bloodstream can cause other types of damage to body tissues, which can increase the risk of heart disease and stroke, kidney disease, vision problems, and nerve problems in people with diabetes. These problems don't usually show up in kids or teens with diabetes who have had the disease for only a few years. However, they can happen in adulthood in some people, particularly if they haven't managed or controlled their diabetes properly. Blood sugar levels are considered high when they're above someone's target range. The diabetes health care team will let you know what your child's target blood sugar levels are, which will vary based on factors like your child's age. A major goal in controlling diabetes is to keep blood sugar levels as close to the desired range as possible. It's a three-way balancing act of: diabetes medicines (such as in Continue reading >>

Diabetic Ketoacidosis In Dogs

Diabetic Ketoacidosis In Dogs

My dog is diabetic. He has been doing pretty well overall, but recently he became really ill. He stopped eating well, started drinking lots of water, and got really weak. His veterinarian said that he had a condition called “ketoacidosis,” and he had to spend several days in the hospital. I’m not sure I understand this disorder. Diabetic ketoacidosis is a medical emergency that occurs when there is not enough insulin in the body to control blood sugar (glucose) levels. The body can’t use glucose properly without insulin, so blood glucose levels get very high, and the body creates ketone bodies as an emergency fuel source. When these are broken down, it creates byproducts that cause the body’s acid/base balance to shift, and the body becomes more acidic (acidosis), and it can’t maintain appropriate fluid balance. The electrolyte (mineral) balance becomes disrupted which can lead to abnormal heart rhythms and abnormal muscle function. If left untreated, diabetic ketoacidosis is fatal. How could this disorder have happened? If a diabetic dog undergoes a stress event of some kind, the body secretes stress hormones that interfere with appropriate insulin activity. Examples of stress events that can lead to diabetic ketoacidosis include infection, inflammation, and heart disease. What are the signs of diabetic ketoacidosis? The signs of diabetic ketoacidosis include: Excessive thirst/drinking Increased urination Lethargy Weakness Vomiting Increased respiratory rate Decreased appetite Weight loss (unplanned) with muscle wasting Dehydration Unkempt haircoat These same clinical signs can occur with other medical conditions, so it is important for your veterinarian to perform appropriate diagnostic tests to determine if diabetic ketoacidosis in truly the issue at hand Continue reading >>

Ch. 21 - Nursing 500a With Ritter At University Of Arizona - Studyblue

Ch. 21 - Nursing 500a With Ritter At University Of Arizona - Studyblue

Diabetes insipidus is caused by insufficient secretion of insulin Giantism occurs only in children and adolescents. A person with syndrome of inappropriate antiduretic hormone (SIADH) usually craves fluids. Abnormal immunologic mechanisms producing autoantibodies are responsible for Graves disease as well as hypothyroidism. Thyroid carcinoma, although rare, is the most common endocrine malignancy. Myxedema coma is caused by severe hypoparathyroidism. Type 2 diabetes mellitus is more common than type 1. The most common cause of hypoparathyroidism is damage to the glands during surgery. Individuals with type 2 diabetes mellitus have a greater degree of pancreatic changes than individuals with type 1 diabetes. Syndrome of inappropriate antidiuretic hormone (SIADH) is characterized by increased levels of antidiuretic hormone (ADH) Glucose levels are considerably lower in hyperosmolar hyperglycemic nonketotic syndrome (HHNKS) than in diabetic ketoacidosis (DKA) The effects of syndrome of inappropriate antidiuretic hormone (SIADH) include solute: The most common cause of elevated levels of antidiuretic hormone (ADH) secretion is Which of the following laboratory values would the nurse expect to find if a person is experiencing syndrome of inappropriate antidiuretic hormone (SIADH)? a. hypernatremia and urine hypo-osmolality c. Serum Na+120 and serum hypo-osmolality c. Serum Na+120 and serum hypo-osmolality a. antidiuretic hormone (ADH) hyposecretion. b. antidiuretic hormone (ADH) hypersecretion. a. antidiuretic hormone (ADH) hyposecretion. Man w/ closed head injury urine output = 6 - 8 L/day. Electrolytes w/in normal limits; ADH level low. Although he has had no intake for 4 hours, there is no change in polyuria. These indicate: Visual disturbances are a result of a pituitar Continue reading >>

Diabetes Warning: Do Not Ignore These Signs Of Type 1 And Type 2 Diabetes

Diabetes Warning: Do Not Ignore These Signs Of Type 1 And Type 2 Diabetes

Diabetes symptoms include urinating more than normal Type 1 and 2 symptoms are similar Having an unquenchable thirst and feeling more tired than usual are also symptoms Untreated diabetes could lead to diabetic ketoacidosis Type 1 and type 2 diabetes are different conditions, but they present similar symptoms. However the majority of people with type 1 diabetes are diagnosed in childhood and early adulthood. The signs of type 1 and type 2 diabetes should never be ignored. If they are not treated, the condition can lead to serious and complex health conditions, such as diabetic ketoacidosis. Untreated type 2 diabetes can affect the heart, blood vessels, nerves, eyes and kidneys. The common symptoms of diabetes include: Going to the toilet a lot, especially at night Excessive urination can be triggered by excess glucose in the blood which interferes with the kidney’s ability to concentrate urine. Being really thirsty The medical term for increased thirst is puldisia. Feeling thirsty all the time, or having a stronger thirst than usual, which continues after drinking can be a sign of diabetes Feeling more tired than usual Feeling tired can be a symptom of low blood sugar. Losing weight without trying to Although type 2 diabetes commonly occurs in people who are overweight - undiagnosed type 1 diabetes can make people lose weight. Being overweight can cause type 2 diabetes because the body has more pressure to use insulin properly to manage blood sugar levels. Genital itching or thrush Thrush is more common in people with diabetes. This is because high sugar levels can cause yeast to grow. A dry mouth - also a symptom of the condition - can also increase the risk of the infection Cuts and wounds take longer to heal This occurs because diabetes can affect the immune system 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 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 >>

Ketoacidosis At Diagnosis Of Type 1 Diabetes In Children And Adolescents: Frequency And Clinical Characteristics

Ketoacidosis At Diagnosis Of Type 1 Diabetes In Children And Adolescents: Frequency And Clinical Characteristics

Abstract Diabetic ketoacidosis (DKA) is a potentially life-threatening acute complication of type 1 diabetes mellitus (T1DM). Although the frequency of DKA as first manifestation of T1DM is higher in developing compared developed countries, there is paucity of information on its characteristics in developing countries. Methods This retrospective study determined the frequency of ketoacidosis at diagnosis of new-onset type 1 diabetes and described the clinical characteristics of the patients seen between 1996 and 2011 by auditing the hospital records of all cases. The diagnosis of diabetic ketoacidosis (DKA) was based on the presence of hyperglycaemia (blood glucose > 11 mmol/L), acidosis (serum bicarbonate < 15 mmol/L) and ketonuria (urine ketone ≥1+). At diagnosis of new-onset type 1 diabetes mellitus, three-quarter (77.1%) of the children and adolescents presented with DKA. Comparing the frequency of DKA during the initial 8 years (1996–2003) with the later 8 years (2004–2011), it was 81.8% vs 73.1%; p > 005. The frequency has not shown any significant declined over a 16-year period. The frequency of re-admission in ketoacidosis was 24.3%. Three-quarter of children and adolescents present with DKA as first manifestation of T1DM with no significant decline in frequency over a 16-year period in our hospital. Introduction Diabetic ketoacidosis (DKA) is a potentially life-threatening acute complication of type 1 diabetes mellitus (T1DM), characterized by a biochemical triad of hyperglycaemia, ketonaemia (ketonuria) and acidaemia.1 DKA is caused by a decrease in effective circulating insulin associated with elevations in counterregulatory hormones [1, 2]. The likelihood of ketoacidosis occurring at the onset of diabetes varies considerably (between 15% and 67%) from Continue reading >>

Clinical Signs Of Diabetes Mellitus In Dogs And Cats

Clinical Signs Of Diabetes Mellitus In Dogs And Cats

Clinical signs are useful in the diagnosis and monitoring of canine and feline diabetes. Other laboratory tests are also necessary for diagnosis of diabetes mellitus and the monitoring of treated diabetic pets. There are three distinct clinical pictures in diabetes mellitus: Uncomplicated diabetes mellitus The classical signs are Polyuria, Polydipsia, Polyphagia, Cachexia and increased susceptibility to infections (e.g. urinary tract infections). In long term diabetes, effects due to protein glycosylation can be seen: cataracts (mainly in dogs) and peripheral neuropathy (mainly in cats). Diabeties complicated by ketoacidosis DKA develops due to long standing undiagnosed diabetes mellitus, insufficient insulin dose in treated diabetics and impaired insulin action and/or resistance, caused by obesity, concurrent illness or drugs. This is the cause of more than two thirds of cases of DKA. Due to the lack of insulin, glucose cannot be used as an energy source. Fats are broken down to provide energy. During lipolysis, high levels of ketones are produced. Ketosis and acidosis develop and are accompanied by electrolyte imbalances. Ketosis causes anorexia, nausea and lethargy. Diagnosis The diagnosis of DKA is based on the presence of ketonuria along with signs of systemic illness. Treatment DKA is an emergency and treatment must be started as soon as possible. The goals of treatment are to correct fluid deficits, acid-base balance and electrolyte balance, lower blood glucose and ketone concentrations and recognize and correct underlying and precipitating factors. Therapy includes intravenous fluid therapy with isotonic fluids, e.g. 0.9% saline, and intravenous administration of rapid-acting insulin. If possible the electrolyte concentrations and acid-base balance should be mea Continue reading >>

[frequency And Clinical Manifestation Of Diabetic Ketoacidosis In Children Withnewly Diagnosed Type 1 Diabetes].

[frequency And Clinical Manifestation Of Diabetic Ketoacidosis In Children Withnewly Diagnosed Type 1 Diabetes].

1. Pediatr Endocrinol Diabetes Metab. 2013;19(4):143-7. [Frequency and clinical manifestation of diabetic ketoacidosis in children withnewly diagnosed type 1 diabetes]. Chumicki M, Prokopowicz Z, Deja R, Jarosz-Chobot P. INTRODUCTION: Diabetic ketoacidosis (DKA) is still the most dangerous acutecomplication of type 1 diabetes mellitus (T1DM). It is a life-threateningcondition requiring intensive treatment. DKA may be the first symptom ofpreviously undiagnosed diabetes, especially in children.AIM OF THE STUDY: Assessment of the incidence and clinical manifestation ofdiabetic ketoacidosis in children with newly diagnosed type 1 diabetes.MATERIAL AND METHODS: We analyzed 535 medical files of children (aged 9 months to17 years, mean age 4.41-9.96, 261 girls (48%)) hospitalized from 2006 to 2009because of the newly diagnosed type 1 diabetes mellitus. DKA was diagnosed(according to ISPAD) in children with pH <7.3, blood glucose level >11 mmol/L(>200 mg/dL) and/or blood concentration of bicarbonate <15 mmol/L with ketonuria.Severe DKA was diagnosed in children with pH <7.2.RESULTS: DKA was diagnosed in 123 patients (23%) (63 girls (51%)). The mean ageof children with DKA was significantly lower than the age of the children withoutDKA (9.05-4.45 vs 9.48-4.39 years; p<0.001). Mean pH was 7.21-1.03 (min. 6,82;max. 7,30). In 32.5% of children with DKA severe ketoacidosis (pH -7.2) wasobserved. The prevalence of acidosis was higher in the 0-4 age group compared to children over 4 years (28 vs. 22%, p<0.001). Neither sex, nor symptoms durationwere associated with the development of DKA. Polyuria (95%), polydipsia (95%),weight loss (85%) and abdominal pain (50%) were the most common symptoms reportedby patients.CONCLUSIONS: Despite the typical symptomatology of type 1 diabetes melli Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

List Clinicopathologic features that might be present with DKA? Elevation in liver enzymes (hepatic lipidosis, pancreatitis) Hyperlipidemia Hyperlipasemia Hyperamylasemia Metabolic Acidosis Serum Hyperosmolality Azotemia (usually pre-renal) Hemeturia, pyuria, bactiuria (always submit cysto for culture an dsensitivity) Ketonuria Continue reading >>

Medical Pharmacology: Diabetes

Medical Pharmacology: Diabetes

Free fatty acids from fat stores are primary substrates for ketone body formation High plasma free fatty acid levels are required for significant ketogenesis Normally the concentration of plasma free fatty acids are lowered by the liver where fatty acids are reesterified and stored as hepatic triglyceride or converted into VLDL -- unless the system for hepatic oxidation of fatty acids becomes activated. Release of free fatty acids is increased by insulin deficiency; accelerated hepatic fatty acid oxidation is caused by glucagon-- by acting on carnitine palmitoyltransferase enzymes (CPT) Activation of carnitine palmitoyltransferase I (CPT I), normally inactive, is activated by uncontrolled diabetes (or starvation) Activation of carnitine palmitoyltransferase I (CPT I) allows long-chain free fatty acids to reach beta-oxidative enzymes localized in the mitochondrial matrix where ketone body production occurs. Significant acetoacetate and beta-hydroxybutyrate production by the liver require: (a) Enough free fatty acid substrate and (b) Activation of fatty acid oxidation. Lipolysis is enhanced by insulin deficiency. Immediate signal for oxidation is a fall in malonyl-CoA concentration. figure above adapted from: Figure 334-4 Foster, D. W., Diabetes Mellitus, In Harrison's Principles of Internal Medicine 14th edition, (Isselbacher, K.J., Braunwald, E., Wilson, J.D., Martin, J.B., Fauci, A.S. and Kasper, D.L., eds) McGraw-Hill, Inc (Health Professions Division), 1998, p 2072. 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 >>

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 >>

(pdf) Diabetic Ketoacidosis: Clinical Features And Precipitating Factors At Dempu

(pdf) Diabetic Ketoacidosis: Clinical Features And Precipitating Factors At Dempu

1 The Pediatric Department, Diabetes Endocrine and Metabolism Pediatric Unit (DEMPU), Children Hospital, Faculty of Medicine, Cairo University 2 The Pediatric Department, Children Hospital, Faculty of Medicine, Cairo University Amany Ibrahim has no relevant financial or non financial relationships to disclose Egypt is amongst the countries with the highest reported rates of T1DM (8-10 per 100,000 population per year in children aged <15 years) [1]. Diabetic ketoacidosis (DKA) is a serious complication in T1DM children characterized by hyperglycemia, metabolic acidosis, dehydration and ketosis. DKA is a leading cause of mortality in T1DM children, and at diagnosis it might represent delayed presentation. Approximately, 1/3 of T1DM patients present with mild DKA and 1/6 with moderate or severe DKA [2]. Multiple factors affect the risk of developing DKA at the onset of T1DM in children. Delayed and misdiagnosis of DKA are important factors. The extent and reasons for delays are unclear, but identifying and targeting these factors may reduce this incidence [3]. DKA is frequently precipitated by infections, insulin withdrawal or undiagnosed T1DM [4]. The aim of this study was to identify the risk factors and the most common clinical features of newly diagnosed T1DM children, in addition to the factors related to delayed diagnosis or mismanagement in these patients. Over a 3 month period, 99 patients newly diagnosed with T1DM; 53 (24 females and 29 males) of which had DKA and 46 (23 females and 23 males) were hyperglycemic with mean SD age of 6.89 3.63 and 6.75 3.53 were recruited from the inpatient department of the DEMPU, New Medical history was reviewed and a complete data sheet for each patient was created including the mode of presentation of T1DM, symptoms of T1DM befo Continue reading >>

Diabetic Ketoacidosis Symptoms

Diabetic Ketoacidosis Symptoms

What is diabetic ketoacidosis? Diabetic ketoacidosis, also referred to as simply ketoacidosis or DKA, is a serious and even life-threatening complication of type 1 diabetes. DKA is rare in people with type 2 diabetes. DKA is caused when insulin levels are low and not enough glucose can get into the body's cells. Without glucose for energy, the body starts to burn fat for energy. Ketones are products that are created when the body burns fat. The buildup of ketones causes the blood to become more acidic. The high levels of blood glucose in DKA cause the kidneys to excrete glucose and water, leading to dehydration and imbalances in body electrolyte levels. Diabetic ketoacidosis most commonly develops either due to an interruption in insulin treatment or a severe illness, including the flu. What are the symptoms and signs of diabetic ketoacidosis? The development of DKA is usually a slow process. However, if vomiting develops, the symptoms can progress more rapidly due to the more rapid loss of body fluid. Excessive urination, which occurs because the kidneys try to rid the body of excess glucose, and water is excreted along with the glucose High blood glucose (sugar) levels The presence of ketones in the urine Other signs and symptoms of ketoacidosis occur as the condition progresses: These include: Fatigue, which can be severe Flushing of the skin Fruity odor to the breath, caused by ketones Difficulty breathing Type 2 Diabetes Diagnosis, Treatment, Medication What should I do if I think I may have, or someone I know may diabetic ketoacidosis? You should test your urine for ketones if you suspect you have early symptoms or warning signs of ketoacidosis. Call your health-care professional if your urine shows high levels of ketones. High levels of ketones and high blood sug Continue reading >>

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