Dka Pathophysiology For Dummies

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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

Diabetic ketoacidosis is a medical emergency that typically occurs as a complication of type 1 diabetes. It can occur in people with undiagnosed type 1 diabetes or in diabetics with: decreased insulin intake intercurrent illness stress of any form (e.g.infection, surgery, MI) Pathophysiology The pathophysiology (see image) of diabetic ketoacidosis must be considered to help understand its presentation and the necessary management. There are 3 main biochemical features: hyperglycaemia hyperketonaemia metabolic acidosis Firstly, lack of insulin causes glucose to remain in the blood rather than be transferred into cells for utilisation. The body therefore responds as if it were in starvation and hepatic glucose production becomes increased. Osmotic diuresis occurs as a consequence of this glucose rich blood being filtered by the kidneys. Glucose is normally reabsorbed by the proximal tubule but in DKA the amount of glucose filtered exceeds the renal threshold for reabsorbtion. The presence of glucose in the tubules causes water retention in the lumen, thus increasing urine output and decreasing reabsorption into the body, leading to dehydration and electrolyte depletion. Secondly, an Continue reading >>

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  1. Injecto

    I can't seem to find anything that backs this up. I know that high BG will damage them over time (duh!!), but what about ketones?

  2. fgummett

    Ketone bodies are water-soluble compounds that are produced as by-products when fatty acids are broken down for energy. They are a vital source of energy during fasting -- such as overnight.
    The brain gets its energy from ketone bodies when insufficient glucose is available. In the event of low blood glucose, most other tissues have additional energy sources besides ketone bodies (such as fatty acids), but the brain does not.
    Remember that when you are not fasting, the body can use Amino Acids (from dietary Protein) to synthesize Glucose (Gluconeogenesis).
    Any production of Ketones is called ketogenesis, and this is necessary in small amounts. When even larger amounts of ketone bodies accumulate such that the blood's pH is lowered to dangerously acidic levels, this state is called ketoacidosis. This happens in untreated Type I diabetes (DKA).
    In short, the human body has evolved over the millennia to burn either Glucose or Fatty Acids -- think of these as the short-term fuel and longer-term reserve, respectively.
    So if it is normal to burn Fatty Acids and produce Ketones why would they be harmful unless they accumulate to dangerous levels? Yes I know... we always get the "dangerous levels" lecture but consider that BG can be toxic at high enough levels... that does not mean it is bad for us at any level


    can we get the production of ketones correct??
    The primary cause of ketogenesis in the body is.....
    gluconeogenesis from dietary protein, when there is insufficient dietary glucose to fill the body needs, aka the ketogenic diet.
    The process of gluconeogenesis utilises a key component of the citric acid cycle (oxaloacetate), which blocks the oxidation of Acetyl CoA. Fatty acid (and glucose oxidation) require their conversion to Acetyl CoA. It is Acetyl CoA which is converted to ketone bodies and this process occurs pretty exclusively in the liver (also happens in the kidney)
    Normally oxidation of fatty acids does NOT produce ketone bodies, even during fasting overnight, as usually there are more than sufficient stores of glycogen.
    - starvation is an entirely different matter. Fasting for longer than a day or so can be sufficient for ketogenesis to start.
    Astrocytes in the brain can produce ketone bodies in response to hypoglycemia, but this will not provide adequate protection in the event of hypoglycemia caused by insulin overdose.
    The simple reason why ketogenesis as caused by a ketogenic diet is probably safe is because ketones only transiently rise in response to food, and the levels sustained should not be sufficient to disturb the body's buffer system.
    if however you spent long periods without food, or lacking insulin then that is a very different matter.
    I can't find anything definitive about ketones and kidney function - the only thing of note is an association with kidney stones for children on ketogenic diets to control epilepsy - but this could be due to the components of the diet (high protein) rather than ketones. There are no long term safety studies on ketogenic diets, but they are though to be safe (probably).
    Those on this forum on low carbohydrate diets 50g to 120g of carbs probably do not experience ketogenesis to any significant degree. Significant ketogenesis only occurs at <30g.

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Physician Assistant Exam: High Blood Glucose

Make sure you review high blood glucose for the Physician Assistant Eam (PANCE). In people with uncontrolled diabetes mellitus, the blood glucose levels can be super duper high, even >= 1,000 mg/dL. High blood sugars due to uncontrolled diabetes mellitus are usually related to either diabetic ketoacidosis or hyperosmolar hyperglycemic nonketotic coma. These emergency medical conditions require a high level of care, often in the intensive care unit. DKA Diabetic ketoacidosis (DKA) is usually a complication of type 1 diabetes. The person has an insulin deficiency, and without insulin, the body goes into a ketotic, catabolic, acidemic state. This condition can be life-threatening. One way to think about diabetic ketoacidosis is to separate the various components: Diabetic: Blood sugar > 250 mg/dL, although it’s usually a lot higher Keto: Positive serum acetone and positive urine ketones Acidosis: Bicarbonate level < 15 mEq/L and a pH < 7.3 Here are some key points concerning diabetic ketoacidosis: Symptoms of diabetic ketoacidosis can be confusion and lethargy, especially at higher blood glucose levels. Another common symptom is abdominal pain. Sometimes the cause of DKA is more tha Continue reading >>

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  1. anbeav

    It's not detrimental to fat loss. The hate against cardio is against chronic steady state cardio that most traditionally engage in thinking it's the best way to burn fat not realizing that at some point it becomes counterproductive and can just frustrate scale-addicts (water retention) and that you can't outrun your fork. If you like running, run! I love lifting but love cardio as well, they both have their roles in my fitness program.

  2. TomBonner1

    To your point about water retention, are you referring to losing water weight through sweat during a run? And to be honest I never cared about numbers on the scale, it's the inches on/off your waist that matter.

  3. anbeav

    To your point about water retention, are you referring to losing water weight through sweat during a run?
    Nope, cortisol. Prolonged steady state cardio, especially in women, especially in women eating at a deficit, increases cortisol and causes water retention.
    And to be honest I never cared about numbers on the scale, it's the inches on/off your waist that matter.
    Yes, I agree but it's many people (read: women usually) don't get that and all they care about is the number on the scale and too much cardio can cause water retention which leads to unnecessary changes like more cardio or fewer calories

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What is KETOACIDOSIS? What does KETOACIDOSIS mean? KETOACIDOSIS meaning - KETOACIDOSIS definition - 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... Ketoacidosis is a metabolic state associated with high concentrations of ketone bodies, formed by the breakdown of fatty acids and the deamination of amino acids. The two common ketones produced in humans are acetoacetic acid and ß-hydroxybutyrate. Ketoacidosis is a pathological metabolic state marked by extreme and uncontrolled ketosis. In ketoacidosis, the body fails to adequately regulate ketone production causing such a severe accumulation of keto acids that the pH of the blood is substantially decreased. In extreme cases ketoacidosis can be fatal. Ketoacidosis is most common in untreated type 1 diabetes mellitus, when the liver breaks down fat and proteins in response to a perceived need for respiratory substrate. Prolonged alcoholism may lead to alcoholic ketoacidosis. Ketoacidosis can be smelled on a person's breath. This is due to acetone, a direct by-product of the spontaneous decomposition of acetoacetic acid. It is often described as smelling like fruit or nail polish remover. Ketosis may also smell, but the odor is usually more subtle due to lower concentrations of acetone. Treatment consists most simply of correcting blood sugar and insulin levels, which will halt ketone production. If the severity of the case warrants more aggressive measures, intravenous sodium bicarbonate infusion can be given to raise blood pH back to an acceptable range. However, serious caution must be exercised with IV sodium bicarbonate to avoid the risk of equally life-threatening hypernatremia. Three common causes of ketoacidosis are alcohol, starvation, and diabetes, resulting in alcoholic ketoacidosis, starvation ketoacidosis, and diabetic ketoacidosis respectively. In diabetic ketoacidosis, a high concentration of ketone bodies is usually accompanied by insulin deficiency, hyperglycemia, and dehydration. Particularly in type 1 diabetics the lack of insulin in the bloodstream prevents glucose absorption, thereby inhibiting the production of oxaloacetate (a crucial molecule for processing Acetyl-CoA, the product of beta-oxidation of fatty acids, in the Krebs cycle) through reduced levels of pyruvate (a byproduct of glycolysis), and can cause unchecked ketone body production (through fatty acid metabolism) potentially leading to dangerous glucose and ketone levels in the blood. Hyperglycemia results in glucose overloading the kidneys and spilling into the urine (transport maximum for glucose is exceeded). Dehydration results following the osmotic movement of water into urine (Osmotic diuresis), exacerbating the acidosis. In alcoholic ketoacidosis, alcohol causes dehydration and blocks the first step of gluconeogenesis by depleting oxaloacetate. The body is unable to synthesize enough glucose to meet its needs, thus creating an energy crisis resulting in fatty acid metabolism, and ketone body formation.

Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a medical emergency that can happen in people with diabetes mellitus. DKA happens mostly in people with Type 1 diabetes, although it may happen in some people that have Type 2 diabetes. DKA happens when a person does not have enough insulin in their body. All of the cells in the body need glucose (sugar) to survive, because the body needs sugar to make energy. Insulin breaks down glucose into a form that the body can use for energy. Without insulin, sugar stays in the blood and cannot get into the cells. This causes high blood sugar levels and makes it impossible for the cells to use glucose to make energy. DKA can be caused by not having enough insulin, eating too many carbohydrates, and sometimes physical or mental stress. DKA can also be a sign that a person has diabetes that has not been discovered, or is not being controlled well. DKA is diagnosed through blood and urine testing. These tests will show high blood sugar, which does not happen with other forms of ketoacidosis. DKA was first discovered around 1886. Before insulin therapy was first used in the 1920s, DKA almost always caused death. The "3 polys" of DKA: Polydipsia (feeling very thirst Continue reading >>

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  1. v_prediabetic

    my mom was an insulin dependent type 2 (maybe LADA?). at the end of her life she was on hospice care and did not receive insulin. just a little food and water and morphine until she wouldn't open her mouth anymore. then she just had a glazed look with her eyes open. she wasn't getting any food, so maybe she wasn't in DKA. are there any special considerations for insulin dependent diabetics during the hospice/palliative care stage? is there anything different that needs to be done to ease their suffering?

  2. Rphil2

    I have had a parent (my mom), a type 1, in hospice. She was not there long. Basically what you experienced is very similar to what my mom experienced in 1986. mom did come from ICU to hospice and he stay in ICU was definitely like what you experienced.


  3. Holger

    A person with fully developed T1 Diabetes has lost most of its beta cell mass due to an autoimmune process that killed the cells. LADA is Type 1 Diabetes with the exception that the autoimmune process has a less aggressive progression. Usually LADA patients can preserve residual beta cells for a longer period of time. Only a full panel of very specific lab tests can identify the exact type of diabetes. Even T2 patients can loose much of their beta cells due to exhaustion. If a person has less insulin than needed then exogenous insulin is the only choice. Metformin can help to moderate the glucose output of the liver to lower levels. But it can not replace the functionality of insulin. The body needs insulin to have access to carbohydrate based energy sources. Without insulin the body will convert body fat and muscles to energy. This process is very exhausting and creates many unwanted side products like ketones. These will accumulate in the blood creating a very dangerous condition called DKA. Usually these patients and their rooms have a strong acetonic smell due to the ketones. A patient in the hospice should receive at least the basal insulin to prevent DKA. Otherwise it would be a form of neglect. I very much hope your mother did not have to suffer from the decision of the hospice.

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