diabetestalk.net

Dka Pathophysiology Made Simple

Diabetic Ketoacidosis: Clinical Practice Guidelines

Diabetic Ketoacidosis: Clinical Practice Guidelines

1. Introduction Diabetic ketoacidosis (DKA), the most common endocrinal emergency remains a life-threatening condition despite improvements in diabetes care [1]. The mortality and morbidity rates remain high worldwide, especially in developing countries and among non-hospitalized patients [2,3], which highlight the importance of early diagnosis and implementation of effective preventive and management strategies. The adage "The child is not a miniature adult" is most appropriate when considering DKA. The fundamental pathophysiology of DKA is the same in children as in adults; however, the child differs from the adult in a number of characteristics which raise some important considerations in management [2]. The purpose of this chapter is to briefly review the pathophysiology of DKA and discuss recommended treatment protocols and current standards of care pertaining to children, adolescents and adults with type 1 or 2 diabetes presenting with DKA. The information provided is based on evidence from published studies and internationally accepted guidelines whenever possible and, when not, supported by expert opinion or consensus [1-5]. Current concepts of cerebral edema, recommendations and strategies for the prediction and prevention of DKA and hence its complications are finally presented. The considerations and recommendations included are in agreement with those endorsed by the American Diabetes Association (ADA), Lawson Wilkins Pediatric Endocrine Society (LWPES), European Society for Pediatric Endocrinology (ESPE), and the International Society for Pediatric and Adolescent Diabetes (ISPAD) [2-5]. Thus, this book chapter will provide easy and practical information to guide healthcare professional who manage DKA in all age groups. 2. Definition of Diabetic Ketoacidosis Continue reading >>

Diabetes And Hypoglycemia Video Classroom

Diabetes And Hypoglycemia Video Classroom

Diabetes Overview Beginning Signs of Diabetes Pathophysiology of Diabetic Nephropathy Glucose Insulin and Diabetes (Kahn) Juvenile Diabetes Research Foundation Animation about Diabetes Subtle Warning Signs of Diabetes Diabetes Animation Diabetes Made Simple A Day Living with Diabetes Pathophysiology of Diabetes Mellitus Be Diabetes Prepared Health and Science in Diabetes Role of Insulin in Body Living with Diabetes: Documentary What is Diabetes? Diabetes Type 2: Animation Diabetes Symptoms in Men Glucose Animation Diabetes Emergencies 1 Managing Diabetes Insulin Resistence Diabetes: Foot Care Complications of Diabetes Diabetes Emergencies 2 Type 1 Diabetes Medical Science on Type 2 Diabetes Exercise in Diabetics Type 1 Diabetes Animation Diabetes Emergencies 3 Type 2 Diabetes Board Review: Type 1 and 2 Diabetes Diabetes: Excercise: Reverse Resistence 2 Diabetes Animation Treating Hypoglycemia Quickly What is Type 1 Diabetes Management of Diabetes Diabetes: Excercise as Medicine Metformin Medication Hypoglycemia Pathophysiology of Diabetes Pathophysiology of Diabetes 2 Made Easy Diabetes Animation Metformin for Diabetes Diabetic Ketoacidosis Diabetes: Progress in Stem Cell Research Diabetic Nephropathy for the Non-Nephrologist Diabetes Education Diabetes Medications Diabetic DKA Embryonic Stem Cell Diabetes Research Diabetic Retinopathy Insulin, Glucose and You Metformin Still the Best! Inpatient Diabetes Management Diabetes Basics Diabetic Eye Disease Insulin: Synthesis and Secretion 1 Understanding Diabetes Type 2 Hyperglycemic Crises: Part 1 Diabetes Symptoms Obesity and Diabetes Insulin: Synthesis and Secretion 2 Diabetes Update 2010 Hyperglycemic Crises: Part 2 Diabetes: Complications Metabolism and Nutrition: Diabetes Insulin: Synthesis and Secretion 3 Juvenile Dia Continue reading >>

Spilleautomater Dka Pathophysiology Made

Spilleautomater Dka Pathophysiology Made

Spilleautomater Dka Pathophysiology Made Related Images "Spilleautomater Dka Pathophysiology Made" (307 pics): Diabetic Ketoacidosis DKA Nursing Diabetes Care Dka Guidelines: : Pathophysiology Of Diabetes Mellitus Diabetes Care Dka Guidelines The web has definitely made lifestyle a lot. Diabetic ketoacidosis (DKA) continues to have high rates of morbidity and mortality despite advances in the Pathophysiology of Diabetic Ketoacidosis. Why Do Not Click To Get it diabetes pathophysiology made simple, You Want Something Special About diabetes. Diabetes Dka Symptoms He is the author of Diabetes Control Made easy. Diabetes Dka Symptoms Today I am writing about any complication that sometimes. Diabetic ketoacidosis (DKA) is a complex disordered metabolic state characterized by hyperglycemia, ketoacidosis, and ketonuria. Pathophysiology Of Diabetes Mellitus Diabetes Medication Made Easy The 3 Step Trick that Reverses Diabetes Permanently in As Little as 11 Days. Diabetes Care Dka Sglt2 Lactulose And Diabetes The 3 Step Trick that Reverses Diabetes Permanently in As Little as 11 Days. Diabetic ketoacidosis (DKA) is an acute, major, lifethreatening complication of diabetes that mainly occurs in patients with type 1 diabetes, but it is. Warnings are typically not custommade. Dka Diabetic Ketoacidosis There will not be reversing diabetes type 2 in these diets. Management of diabetic ketoacidosis in adults. Pathophysiology DKA results from a dysregulation of carbo made up with 50ml normal saline. Diabetes Mellitus Pathophysiology for maintaining a tally of your regimens and how well it is or is not working for you and any adjustments which can be made. Definition: Metabolic aniongap acidosis due to elevated serum ketones PATHOPHYSIOLOGY Acidemia Osmotic immediate postDKA stage nursi Continue reading >>

Pediatric Diabetic Ketoacidosis

Pediatric Diabetic Ketoacidosis

Pediatric Diabetic Ketoacidosis Authors: Katia M. Lugo-Enriquez, MD, FACEP, Faculty, Florida Hospital Emergency Medicine Residency Program, Orlando, FL. Nick Passafiume, MD, Florida Hospital Emergency Medicine Residency Program, Orlando, FL. Peer Reviewer: Richard A. Brodsky, MD, Pediatric Emergency Medicine, St. Christopher's Hospital for Children, Assistant Professor, Drexel University, Philadelphia, PA. Children with diabetes, especially type 1, remain at risk for developing diabetic ketoacidosis (DKA). This may seem confounding in a modern society with such advanced medical care, but the fact remains that children who are type 1 diabetics have an incidence of DKA of 8 per 100 patient years.1 In fact, Neu and colleagues have noted in a multicenter analysis of 14,664 patients in Europe from 1995 to 2007 that there was no significant change in ketoacidosis presenting at diabetes onset in children.2 In children younger than 19 years old, DKA is the admitting diagnosis in 65% of all hospital admissions of patients with diabetes mellitus.3 This article reviews the presentation, diagnostic evaluation, treatment, and potential complications associated with pediatric DKA. — The Editor Introduction The overall mortality rate for children in DKA is not unimpressive: The range is 0.15% to 0.31%.4 Besides death, one of the most feared repercussions of DKA in children is cerebral edema, an entity that occurs approximately 1% of the time.5,6 Cerebral edema, with the exception of a few case reports in some young adults, has largely been a complication of treatment in the pediatric population, and the exact factors have yet to be completely determined. The mortality associated with cerebral edema may approach 20% to 50%, and the incidence of neurologic morbidity is significant and Continue reading >>

Developments In The Management Of Diabetic Ketoacidosis In Adults: Implications For Anaesthetists

Developments In The Management Of Diabetic Ketoacidosis In Adults: Implications For Anaesthetists

Diabetic ketoacidosis (DKA) is a medical emergency and bedside capillary ketone testing allows timely diagnosis and identification of successful treatment. 0.9% saline with premixed potassium chloride should be the main resuscitation fluid on the general wards and in theatre; this is because it complies with National Patient Safety Agency recommendations on the administration of potassium chloride. Weight-based fixed rate i.v. insulin infusion (FRIII) is now recommended rather than a variable rate i.v. insulin infusion (VRIII). The blood glucose must be kept above 14 mmol litre−1 with the FRIII. Precipitating factor(s) needs to be identified and treated. Surgery and also critical care may be indicated to manage the patient presenting with DKA. Diabetic ketoacidosis (DKA) is a medical emergency. The diagnostic triad is: DKA can occur in both type 1 and type 2 diabetes mellitus and, although preventable, it remains a frequent and life-threatening complication. Errors in the management of DKA are not uncommon and are associated with significant morbidity and mortality. The majority of mortality and morbidity in DKA are attributable to delays in presentation and initiation of treatment. Rapid recognition and treatment of DKA is critical. Ketonaemia ≥3.0 mmol litre−1 or significant ketonuria (more than 2+ on urine sticks) Blood glucose >11.0 mmol litre−1 or known diabetes mellitus Bicarbonate <15.0 mmol litre−1, venous pH <7.3, or both. To overcome these concerns and to highlight current management strategies, the Joint British Diabetes Societies (JBDS) published guidelines in 2010. This was updated in consultation with the Intensive Care Society in September 2013.1 This article will review the pathophysiology of DKA and highlight the modern management of DKA that Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

I. Review of normal lipid metabolism Triglycerides in adipose ==lipolysis==> Long-chain FAs Long-chain FAs==hepatic beta-oxidation==>Acetyl CoA Acetyl CoA==hepatic ketogenesis==>ketone bodies Ketone bodies are Beta-hydroxybutyrate and Acetoacetate Beta-OHB is oxidized to AcAc-; their relative concentrations depend on redox state of cell; Beta-OHB predominates in situation favoring reductive metabolism (e.g. decreased tissue perfusion, met. acidosis, catabolic states--like DKA!) Typical ratio Beta-OHB:AcAc- is 3:1; us. increases in DKA II. Hormonal influences on glucose and lipid metabolism Insulin In liver, increases glu uptake from portal blood; stimulates glycogenesis, inhibits glycogenolysis and gluconeogenesis In skeletal muscle, increases glu uptake from blood, stimulates protein synth, inhibits proteolysis In adipose tissue, required for glu and lipoprotein uptake from blood; stimulates lipogenesis, inhibits lipolysis Tissues which don't require insulin to transport glucose into cells: brain, renal medulla, formed blood elements Counterregulatory hormones: glucagon (major player in DKA), epi/norepi, cortisol, growth hormone (no acute effects, only over days-weeks) Glucagon: increases hepatic beta-oxidation, ketogenesis, gluconeogenesis and glycogenolysis; decreases hepatic FA synth. Epi/Norepi: increase hepatic gluconeogenesis & glycogenolysis; increases adipose lipolysis; decreases peripheral glu utilization Cortisol: major effect is decreased peripheral glu utiliz; little effect on production Growth hormone: increases hepatic gluconeogenesis and glycogenolysis; increases adipose lipolysis In high counterreg. hormone states (see above), require high levels of insulin to avoid progressive hyperglycemia and ketoacidosis--glucagon levels in DKA are 5-6 x nl* III. Pa Continue reading >>

Sickly Sweet: Understanding Diabetic Ketoacidosis

Sickly Sweet: Understanding Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a potentially life threatening condition that can occur to people with diabetes. It is observed primarily in people with type 1 diabetes (insulin dependent), but it can occur in type 2 diabetes (non-insulin dependent) under certain circumstances. The reason for why it is not often seen in people with type 2 diabetes is because their body is still able to produce insulin, so the pathophysiology explained in the flowchart below is not as dramatic as compared to people with type 1 diabetes who do not make any insulin at all. There are various symptoms associated with DKA including: Hyperglycaemia Polyphagia (increased appetite and hunger) Polydipsia (increased thirst) Polyuria (increased urination) Glycosuria (glucose in the urine) Ketonuria (ketones in urine) Ketones in blood Sweet, fruity breath Tachypnoea leading to Kussmaul breathing (deep and laboured breathing pattern) The body tries to compensate for the ketone bodies (acid) by eliminating carbon dioxide (also an acid) thereby attempting to make the body more alkalotic to normalise the pH The compensation between the metabolic and respiratory system can be read about in this article Decreased bicarbonate The body tries to use the available bicarbonate (base) to buffer the ketone bodies (acid) in order to improve the metabolic ketoacidosis This actually worsens the situation the lower the bicarbonate becomes with a continual production of ketones Increased drowsiness/decreased level of consciousness As the pH decreases and becomes more acidotic, it has a direct effect on decreasing the level of consciousness in a person Increased urea Electrolyte disturbances Tachycardia and other cardiac arrhythmias Tachycardia is often a compensatory mechanism for the hypotension Cardiac arrhythmias a Continue reading >>

Diabetes: Mechanism, Pathophysiology And Management-a Review

Diabetes: Mechanism, Pathophysiology And Management-a Review

Anees A Siddiqui1*, Shadab A Siddiqui2, Suhail Ahmad, Seemi Siddiqui3, Iftikhar Ahsan1, Kapendra Sahu1 Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Jamia Hamdard (Hamdard University), Hamdard Nagar, New Delhi (INDIA)-110062. School of Pharmacy, KIET, Ghaziabad U.P. SGC college of Pharmacy, Baghpat(UP) Corresponding Author:Anees A Siddiqui E-mail: [email protected] Received: 20 February 2011 Accepted: 02 May 2011 Citation: Anees A Siddiqui, Shadab A Siddiqui, Suhail Ahmad, Seemi Siddiqui, Iftikhar Ahsan, Kapendra Sahu “Diabetes: Mechanism, Pathophysiology and Management-A Review” Int. J. Drug Dev. & Res., April-June 2013, 5(2): 1-23. Copyright: © 2013 IJDDR, Anees A Siddiqui et al. This is an open access paper distributed under the copyright agreement with Serials Publication, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Related article at Pubmed, Scholar Google Visit for more related articles at International Journal of Drug Development and Research The prevalence of diabetes is rapidly rising all over the globe at an alarming rate. Over the last three decades, the status of diabetes has been changed, earlier it was considered as a mild disorder of the elderly people. Now it becomes a major cause of morbidity and mortality affecting the youth and middle aged people. According to the Diabetes Atlas 2006 published by the International Diabetes Federation, the number of people with diabetes in India currently around 40.9 million is expected to rise to 69.9 million by 2025 unless urgent preventive steps are taken. The main force of the epidemic of diabetes is the rapid epidemiological transition associated with changes in dietary patterns and decreased physical activity a Continue reading >>

Diabetic Ketoacidosis In Pregnancy

Diabetic Ketoacidosis In Pregnancy

Abstract Diabetic ketoacidosis (DKA) is a life-threatening medical emergency and is characterized by hyperglycemia, acidosis, and ketonemia. DKA is observed in 5–10 % of all pregnancies complicated by pregestational diabetes mellitus. Laboratory findings are as follows: Ketonemia 3 mmol/L and over or significant ketonuria (more than 2+ on standard urine sticks) Blood glucose over 11 mmol/L or known diabetes mellitus Bicarbonate (HCO3 −−) below 15 mmol/L and/or venous pH less than 7.3 Common risk factors for DKA in pregnancy are new-onset diabetes, infections like UTI, influenza, poor patient compliance, insulin pump failure, treatment with β-mimetic tocolytic medications, and antenatal corticosteroids for fetal lung maturity. Patient should be counseled about the precipitating cause and early warning symptoms of DKA. DKA should be treated promptly, and HDU/level 2 facility with trained nursing staff and/or insertion of central line is required during pregnancy for its management. Continuous fetal heart rate monitoring commonly demonstrates recurrent late decelerations. Delivery is rarely indicated as FHR pattern resolves as maternal condition improves. DKA therapy can lead to frequent complication of hypoglycemia and hypokalemia, so glucose and K concentration monitoring should be done judiciously. Maternal mortality is rare now with proper management, but fetal mortality is still quite high ranging from 10 to 35 %. Continue reading >>

Diabetic Ketoacidosis

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 absence of insulin together with elevated stress hormones such as catecholamines, leads to lipolysis, resulting in numerous free fatty acids available for hepatic ketogenesis. Consequently, there is increased ketone body formation by fatty acid oxidation in the liver, leading to an elevated level in the blood. These ketones give a distinct smell to the urine and breath. Thirdly, the ketone bodies lower the pH of the blood resulting in metabolic acidosis. This causes nausea and vomiting resulting in further dehydration. The body compensates for the acidosis by hyperventilation (Kussmals respira 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

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 >>

Understanding The Presentation Of Diabetic Ketoacidosis

Understanding The Presentation Of Diabetic Ketoacidosis

Hypoglycemia, diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar nonketotic syndrome (HHNS) must be considered while forming a differential diagnosis when assessing and managing a patient with an altered mental status. This is especially true if the patient has a history of diabetes mellitus (DM). However, be aware that the onset of DKA or HHNS may be the first sign of DM in a patient with no known history. Thus, it is imperative to obtain a blood glucose reading on any patient with an altered mental status, especially if the patient appears to be dehydrated, regardless of a positive or negative history of DM. In addition to the blood glucose reading, the history — particularly onset — and physical assessment findings will contribute to the formulation of a differential diagnosis and the appropriate emergency management of the patient. Pathophysiology of DKA The patient experiencing DKA presents significantly different from one who is hypoglycemic. This is due to the variation in the pathology of the condition. Like hypoglycemia, by understanding the basic pathophysiology of DKA, there is no need to memorize signs and symptoms in order to recognize and differentiate between hypoglycemia and DKA. Unlike hypoglycemia, where the insulin level is in excess and the blood glucose level is extremely low, DKA is associated with a relative or absolute insulin deficiency and a severely elevated blood glucose level, typically greater than 300 mg/dL. Due to the lack of insulin, tissue such as muscle, fat and the liver are unable to take up glucose. Even though the blood has an extremely elevated amount of circulating glucose, the cells are basically starving. Because the blood brain barrier does not require insulin for glucose to diffuse across, the brain cells are rece 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 >>

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 >>

More in ketosis