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Clinical Manifestations Of Dka

Diabetic Ketoacidosis: A Serious Complication

Diabetic Ketoacidosis: A Serious Complication

A balanced body chemistry is crucial for a healthy human body. A sudden drop in pH can cause significant damage to organ systems and even death. This lesson takes a closer look at a condition in which the pH of the body is severely compromised called diabetic ketoacidosis. Definition Diabetic ketoacidosis, sometimes abbreviated as DKA, is a condition in which a high amount of acid in the body is caused by a high concentration of ketone bodies. That definition might sound complicated, but it's really not. Acidosis itself is the state of too many hydrogen ions, and therefore too much acid, in the blood. A pH in the blood leaving the heart of 7.35 or less indicates acidosis. Ketones are the biochemicals produced when fat is broken down and used for energy. While a healthy body makes a very low level of ketones and is able to use them for energy, when ketone levels become too high, they make the body's fluids very acidic. Let's talk about the three Ws of ketoacidosis: who, when, and why. Type one diabetics are the group at the greatest risk for ketoacidosis, although the condition can occur in other groups of people, such as alcoholics. Ketoacidosis usually occurs in type one diabetics either before diagnosis or when they are subjected to a metabolic stress, such as a severe infection. Although it is possible for type two diabetics to develop ketoacidosis, it doesn't happen as frequently. To understand why diabetic ketoacidosis occurs, let's quickly review what causes diabetes. Diabetics suffer from a lack of insulin, the protein hormone responsible for enabling glucose to get into cells. This inability to get glucose into cells means that the body is forced to turn elsewhere to get energy, and that source is fat. As anyone who exercises or eats a low-calorie diet knows, fa Continue reading >>

What You Should Know About Diabetic Ketoacidosis

What You Should Know About Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a buildup of acids in your blood. It can happen when your blood sugar is too high for too long. It could be life-threatening, but it usually takes many hours to become that serious. You can treat it and prevent it, too. It usually happens because your body doesn't have enough insulin. Your cells can't use the sugar in your blood for energy, so they use fat for fuel instead. Burning fat makes acids called ketones and, if the process goes on for a while, they could build up in your blood. That excess can change the chemical balance of your blood and throw off your entire system. People with type 1 diabetes are at risk for ketoacidosis, since their bodies don't make any insulin. Your ketones can also go up when you miss a meal, you're sick or stressed, or you have an insulin reaction. DKA can happen to people with type 2 diabetes, but it's rare. If you have type 2, especially when you're older, you're more likely to have a condition with some similar symptoms called HHNS (hyperosmolar hyperglycemic nonketotic syndrome). It can lead to severe dehydration. Test your ketones when your blood sugar is over 240 mg/dL or you have symptoms of high blood sugar, such as dry mouth, feeling really thirsty, or peeing a lot. You can check your levels with a urine test strip. Some glucose meters measure ketones, too. Try to bring your blood sugar down, and check your ketones again in 30 minutes. Call your doctor or go to the emergency room right away if that doesn't work, if you have any of the symptoms below and your ketones aren't normal, or if you have more than one symptom. You've been throwing up for more than 2 hours. You feel queasy or your belly hurts. Your breath smells fruity. You're tired, confused, or woozy. You're having a hard time breathing. Continue reading >>

Case Of Diabetic Ketoacidosis As An Initial Presentation Of Cushing’s Syndrome

Case Of Diabetic Ketoacidosis As An Initial Presentation Of Cushing’s Syndrome

Background Diabetic ketoacidosis (DKA) is an acute metabolic disorder characterized by markedly increased circulating ketone bodies e.g. beta-hydroxybutyrate, aceto-acetate and acetone in the presence of hyperglycemia. DKA is a serious and potentially life-threatening metabolic complication of diabetes mellitus. Some well-known precipitants of DKA include new-onset T1DM, insulin withdrawal and acute illness. In this report, we present a subject who presented with DKA as an initial manifestation of Cushing’s disease secondary to ACTH-producing pituitary adenoma. Case presentation A 48-year-old Caucasian woman was admitted with fever, cough, left-sided chest pain, shortness of breath and hemoptysis. She reported amenorrhea of one-year duration. She was a chronic smoker for over 20 years. Patient was unable to provide a detailed history at the time of admission due to acuteness of her illness and respiratory distress. On physical examination, patient was alert, oriented and in moderate respiratory distress with Kussmaul breathing, temperature: 102 F; respiratory rate: 20/min; pulse: 110/min and blood pressure: 148/98 mmHg; body weight: 158 lbs as well as round flushed face with acne, hirsutism and dark purple striae of the abdominal wall (Fig. 1). Lung examination revealed bronchial breath sounds with crackles in the lower left field. Heart evaluation showed normal heart sounds with tachycardia without a murmur, and neurological assessment was unremarkable. Investigation Complete blood count was significant for WBC 21.600/mL with segmented neutrophils 69%. Serum chemistries showed sodium: 134 mM/L (normal: 135–146); potassium: 3.5 mM/L (normal: 3.5–5.3); chloride: 78 mM/L (normal: 98–110); HCO3−: <10 mM/L (normal: 20–31); anion gap: 50 mM/L (normal: 8–16); se Continue reading >>

Management Of Diabetic Ketoacidosis In Adults

Management Of Diabetic Ketoacidosis In Adults

Diabetic ketoacidosis is a potentially life-threatening complication of diabetes, making it a medical emergency. Nurses need to know how to identify and manage it and how to maintain electrolyte balance 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 >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Summarized from Nyenwe E, Kitabchi A. The evolution of diabetic ketoacidosis: An update of its etiology, pathogenesis and management. Metabolism 2016; 65: 507-21 Diabetic ketoacidosis (DKA), which is an acute, potentially life-threatening complication of poorly controlled diabetes, is the subject of a recent comprehensive review article. The authors discuss epidemiological issues, revealing increasing incidence of DKA and decreasing mortality. Once inevitably fatal, DKA now has a reported mortality rate of <1 % in adults and 5 % in the elderly who also have one or more chronic illnesses, in addition to diabetes. They reveal that although DKA more commonly affects those with type 1 diabetes, around a third of cases occur in those with type 2 diabetes. This introductory section also reminds that DKA is characterized by the presence of three cardinal biochemical features: raised blood glucose (hyperglycemia); presence of ketones in blood and urine (ketonemia, ketonuria); and metabolic acidosis. Insulin deficiency is central to the development of these three biochemical abnormalities. The very rare occurrence of euglycemic DKA (DKA with normal blood glucose) is highlighted by reference to recent reports of this condition in patients treated with a relatively new class of antidiabetic drug (the SGLT 2 inhibitors) that reduces blood glucose by inhibiting renal reabsorption of glucose. There follows discussion of factors that precipitate DKA (omission or inadequate dosing of insulin, and infection are the most common triggers), and the possible mechanisms responsible for ketosis-prone type 2 diabetes. This latter condition, which was recognized as an entity only relatively recently, is distinguished by the development of severe but transient failure of pancreatic β-cells to m Continue reading >>

Type 1 Diabetes Complications

Type 1 Diabetes Complications

Type 1 diabetes is complicated—and if you don’t manage it properly, there are complications, both short-term and long-term. “If you don’t manage it properly” is an important if statement: by carefully managing your blood glucose levels, you can stave off or prevent the short- and long-term complications. And if you’ve already developed diabetes complications, controlling your blood glucose levels can help you manage the symptoms and prevent further damage. Diabetes complications are all related to poor blood glucose control, so you must work carefully with your doctor and diabetes team to correctly manage your blood sugar (or your child’s blood sugar). Short-term Diabetes Complications Hypoglycemia: Hypoglycemia is low blood glucose (blood sugar). It develops when there’s too much insulin—meaning that you’ve taken (or given your child) too much insulin or that you haven’t properly planned insulin around meals or exercise. Other possible causes of hypoglycemia include certain medications (aspirin, for example, lowers the blood glucose level if you take a dose of more than 81mg) and alcohol (alcohol keeps the liver from releasing glucose). There are three levels of hypoglycemia, depending on how low the blood glucose level has dropped: mild, moderate, and severe. If you treat hypoglycemia when it’s in the mild or moderate stages, then you can prevent far more serious problems; severe hypoglycemia can cause a coma and even death (although very, very rarely). The signs and symptoms of low blood glucose are usually easy to recognize: Rapid heartbeat Sweating Paleness of skin Anxiety Numbness in fingers, toes, and lips Sleepiness Confusion Headache Slurred speech For more information about hypoglycemia and how to treat it, please read our article on hy 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 >>

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 >>

Clinical Features Of Diabetic Ketoacidosis

Clinical Features Of Diabetic Ketoacidosis

Clinical presentation of DKA may vary according to the severity and comorbid conditions. The symptoms of diabetic ketoacidosis (DKA) usually develop rapidly over 1 day or less and may include: polyuria with polydipsia – commonest presenting symptom weight loss fatigue dyspnea vomiting preceding febrile illness abdominal pain polyphagia Patients may have tachycardia, poor skin turgor, dry mucous membranes, and orthostatic hypotension due to dehydration (1). Deep (Kussmaul) respirations are seen as a compensatory mechanism for metabolic acidosis (1) If severely ill, extreme cases may progress to shock, oliguria and anuria. The breath may have a distinctive fruity smell - ketotic breath; however the ability to detect this smell is absent is a sizeable proportion of the population - and, by extrapolation, the medical population. Mental status of patient may vary from confusion, drowsiness, progressive obtundation to loss of consciousness and coma (1,2) Note: nausea, vomiting, and abdominal pain that may mimic an acute abdominal condition DKA may rarely be precipitated by sepsis, and fever is not part of DKA Reference: Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a serious problem that can occur in people with diabetes if their body starts to run out of insulin. This causes harmful substances called ketones to build up in the body, which can be life-threatening if not spotted and treated quickly. DKA mainly affects people with type 1 diabetes, but can sometimes occur in people with type 2 diabetes. If you have diabetes, it's important to be aware of the risk and know what to do if DKA occurs. Symptoms of diabetic ketoacidosis Signs of DKA include: needing to pee more than usual being sick breath that smells fruity (like pear drop sweets or nail varnish) deep or fast breathing feeling very tired or sleepy passing out DKA can also cause high blood sugar (hyperglycaemia) and a high level of ketones in your blood or urine, which you can check for using home-testing kits. Symptoms usually develop over 24 hours, but can come on faster. Check your blood sugar and ketone levels Check your blood sugar level if you have symptoms of DKA. If your blood sugar is 11mmol/L or over and you have a blood or urine ketone testing kit, check your ketone level. If you do a blood ketone test: lower than 0.6mmol/L is a normal reading 0.6 to 1.5mmol/L means you're at a slightly increased risk of DKA and should test again in a couple of hours 1.6 to 2.9mmol/L means you're at an increased risk of DKA and should contact your diabetes team or GP as soon as possible 3mmol/L or over means you have a very high risk of DKA and should get medical help immediately If you do a urine ketone test, a result of more than 2+ means there's a high chance you have DKA. When to get medical help Go to your nearest accident and emergency (A&E) department straight away if you think you have DKA, especially if you have a high level of ketones in Continue reading >>

Clinical Presentation Of Diabetes Mellitus

Clinical Presentation Of Diabetes Mellitus

The body appears unable to sense glucose levels directly, but people with diabetes learn to appreciate when their blood glucose is outside the normal range by indirect cues, such as thirst when the glucose is too high and sweating and palpitations when it is too low. Diabetes may present acutely, with the three classic symptoms of thirst, polyuria and weight loss; even so, clinical recognition may be delayed until the patient is seriously ill. Many forms of diabetes, including type 2, present less dramatically. Increased thirst and polyuria may not be noticed because they develop slowly, and weight loss may be welcomed by those who are trying to diet. People at this stage of diabetes may call on their doctor with a range of non-specific symptoms such as tiredness and loss of energy; alternatively they may come to notice because of acute complications of diabetes, including hyperglycaemia emergencies and infections, or longer term complications including retinopathy, neuropathy, cataracts, cardiovascular or cerebrovascular disease. People with type 2 diabetes may have had the condition for several years before they come to clinical notice, and many countries now have screening policies to allow earlier detection and treatment. Background Early recognition of diabetes is important, not least because delayed recognition may result in hospital admission with a metabolic emergency. Delayed recognition of type 2 diabetes may mean that avoidable long term complications of diabetessuch as retinopathyor neuropathyare already present at diagnosis. The classic symptoms of diabetes form the triad of thirst, polyuria and weight loss: Thirst arises as a consequence of dehydration resulting from loss of fluid, salt and other electrolytes in the urine. The acute thirst of type 1 diabet Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Print Overview Diabetic ketoacidosis is a serious complication of diabetes that occurs when your body produces high levels of blood acids called ketones. The condition develops when your body can't produce enough insulin. Insulin normally plays a key role in helping sugar (glucose) — a major source of energy for your muscles and other tissues — enter your cells. Without enough insulin, your body begins to break down fat as fuel. This process produces a buildup of acids in the bloodstream called ketones, eventually leading to diabetic ketoacidosis if untreated. If you have diabetes or you're at risk of diabetes, learn the warning signs of diabetic ketoacidosis — and know when to seek emergency care. Symptoms Diabetic ketoacidosis signs and symptoms often develop quickly, sometimes within 24 hours. For some, these signs and symptoms may be the first indication of having diabetes. You may notice: Excessive thirst Frequent urination Nausea and vomiting Abdominal pain Weakness or fatigue Shortness of breath Fruity-scented breath Confusion More-specific signs of diabetic ketoacidosis — which can be detected through home blood and urine testing kits — include: High blood sugar level (hyperglycemia) High ketone levels in your urine When to see a doctor If you feel ill or stressed or you've had a recent illness or injury, check your blood sugar level often. You might also try an over-the-counter urine ketones testing kit. Contact your doctor immediately if: You're vomiting and unable to tolerate food or liquid Your blood sugar level is higher than your target range and doesn't respond to home treatment Your urine ketone level is moderate or high Seek emergency care if: Your blood sugar level is consistently higher than 300 milligrams per deciliter (mg/dL), or 16.7 mill Continue reading >>

Symptoms Of Diabetic Ketoacidosis

Symptoms Of Diabetic Ketoacidosis

Diabetic ketoacidosis, or simply DKA, is one of the complications of diabetes mellitus. It occurs suddenly, is severe and can be life-threatening if neglected. The diabetic ketoacidosis is a complex metabolic state comprising of increased blood glucose levels (hyperglycemia), increased production and presence of ketone acids in the blood (ketonemia) and acidic changes in the internal environment of the body (acidosis). These changes together constitute the diabetic ketoacidosis. Diabetic ketoacidosis is more common in persons with type – 1 as compared to type – 2 diabetes mellitus. Sometimes, it may be the first sign of diabetes mellitus in patients with no previous diagnosis of diabetes. In normal individuals, insulin hormone is produced and secreted by an organ called pancreas. Insulin is necessary for the entry of blood glucose into our cells. Insulin works like a key and unlocks the cellular gates to help glucose enter the cells. The cells use entered glucose to produce energy. In type – 1 diabetes mellitus, the pancreatic cells producing insulin are destroyed. This lack of insulin prevents the entry of blood glucose into our cells as the cellular gates are closed, increasing the blood glucose levels (hyperglycemia). Our body cells starve and cannot utilize glucose for energy despite increased amounts of glucose in our blood. In this starving state, our body burns fats and produces ketones for energy purposes. Ketones have an advantage that they do not need insulin to enter into cells but the ketones also have a disadvantage that they are acidic in nature and when produced in excessive amounts, they change our body environment and make it acidic, which can be life-threatening. The patients often develop ketoacidosis when: They have missed their insulin doses T Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

As fat is broken down, acids called ketones build up in the blood and urine. In high levels, ketones are poisonous. This condition is known as ketoacidosis. Diabetic ketoacidosis (DKA) is sometimes the first sign of type 1 diabetes in people who have not yet been diagnosed. It can also occur in someone who has already been diagnosed with type 1 diabetes. Infection, injury, a serious illness, missing doses of insulin shots, or surgery can lead to DKA in people with type 1 diabetes. People with type 2 diabetes can also develop DKA, but it is less common. It is usually triggered by uncontrolled blood sugar, missing doses of medicines, or a severe illness. Continue reading >>

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