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Dka Ppt 2017

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In this video, Dr. Michael Agus discusses the risk factors, signs, symptoms, and treatment of cerebral edema in diabetic ketoacidosis. Please visit: www.openpediatrics.org OPENPediatrics is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: [email protected] Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause.

Cerebral Edema And Diabetic Ketoacidosis

Cerebral edema is the most feared emergent complication of pediatric diabetic ketoacidosis. Fortunately, it is relatively rare, but the rarity can lead to some confusion when it comes to its management. We recently discussed the use of mannitol and hypertonic saline for pediatric traumatic brain injury, but when should we consider these medications for the patient presenting with DKA? Cerebral Edema is a relatively rare. Incidence <1% of patients with DKA. Overall tends to occur in the newly diagnosed diabetic patient (4.3% vs 1.2%). While rare, it is a devastating complication. 1990 study showed case fatality rate was 64%. Those treated BEFORE respiratory failure had lower rate of mortality (30%). Lesson = treat early! The exact mechanism is not known… and may be varied between individual patients. Signs and Symptoms develop in: 66% within the first 7 hours of treatment (these tend to be younger). 33% within 10-24 hours of treatment. The diagnosis is clinical! ~40% of initial brain imaging of kids with cerebral edema are NORMAL! This is the area that often leads to finger pointing… most often those fingers being pointed toward the Emergency Physician who was initially caring f Continue reading >>

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Popular Questions

  1. Rcroix

    Hello everyone.
    I have been on the 2:5 for about 6 months and lost about 10kg (over 20lbs) So thank you Dr Mosley!
    A lot of the reviews of the fasting lifesyle seem to suggest that it is just a way to reduce average weekly calories, but I’m sure most of you think there is more going on than simple calorie reduction.
    During the last 10 days I didn’t fast as I was on holiday traveling and found it difficult. Amazingly I did not gain any weight. This has happend on two occasions during the last 6 months.
    I think the fasting days are forcing the body to relearn how to burn fat. I’m a bit confused about the correct scientific terms for this ‘lypolysis’ is I believe the breackdown of fats (into amino acids) and ketosis the burning of
    fat as fuel.
    What ever the terminology it seems like the fasting days teach the body a long forgotten trick of switching from available glucose derived from what we just ate, to reserves stored as fat.
    I suggest that this trait applies to non fast days too, hence the lack of weigh gain during holidays.
    I used to do a bit of distance running and am quite familiar with the concept of ‘hitting the wall’. This is when a runner runs out of glucose and has to switch to fat burning (around the 18mile mark). Often that process is difficult, I have had to sit on the ground for about 3 minutes until my legs felt like they would work again.
    I’m not running now so I can’t try a quick marathon to see if the diet has helped with the switch.
    I welcome your thoughts.
    Good luck
    Martin.
    Perhaps Dr Mosely could weigh in on this with some scientific evidence.

  2. zec4peach

    I love science and this is why I love the 5.2 as it makes so much sense.
    Your body will go into ketosis when fasting for a short time, this is probably why some people get headaches. It will also make you very thirsty and wee a lot as your body tries to flush out the by products from fat metabolism. This is a common symptom of type 1 diabetes but obviously they go into a severe more ketoacidosis due to prolonged lack of insulin and metabolism of glucose and start burning muscle for fuel.
    It’s quite complicated stuff but if you google fasting ketosis there’s loads of interesting info online. Michaels book was lacking in any science stuff which is a shame as I think people are interested.
    I know that athletes or very fit people are more efficient at burning fat as they are used to it so yes I think the 5.2 does reset the metabolism in a similar way.
    I have managed to this this after years of cycling and find I can ride for a few hours on an empty stomach. Always need coffee though !!!
    Z

  3. Nika

    Hey Martin!
    I’m also very interested in ketosis. I tried it out a few weeks ago and didn’t eat any carbs for 1,5 week. I lost quite some weight, but felt like I couldn’t sustain it – I started feeling really weak, dizzy, couldn’t walk straight some days and all in all didn’t get the energy boosts some people boast about.
    So now I just cut carbs on my fast days and allow myself fruit and yoghurt on normal days – still prefer not to eat rice, noodles, bread and potatoes though. Sometimes a baked good or chocolate pudding as a treat, but not regularly. I do think this really contributes to my quicker than average weightloss (7kg in 3 weeks, of which most during that first 1,5 week).
    I’ve also started working out fasted. I do this after work before my only meal of the day, so after fasting for over 20 hours. I do HIIT (Insanity), which combines cardio and strength through bodyweight exercises. So far my results have been worse than when I did the program before when eating regularly, but I’m waiting to see how it goes in two weeks when I do my second fit test. My body is most likely also learning how to switch to burning fat efficiently.
    What you said about going on a holiday, this reminded me of the “carb loaders” I know. They basically cut carbs during the week, then they “carbload” on Saturday – eating everything from pizza to ribs to whatever they want. They say that it doesn’t cause them to gain weight, because the body is still in fat burning mode and the glucose from the carbs goes straight to the muscles, giving the muscles the strength to keep working out through the next week. Hence carb ‘loading’. These people are basically in ketosis 3 days a week (it usually takes the body about 3 days to go into full ketosis).
    These are all bodybuilder types though, who do mostly strength training so it doesn’t really sound like a great idea for me. I wanna be lean, not buff.
    Anyway, long post – gonna head over to the next one
    Annika

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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.....

Trends In Diabetic Ketoacidosis Hospitalizations And In-hospital Mortality United States, 20002014

Trends in Diabetic Ketoacidosis Hospitalizations and In-Hospital Mortality United States, 20002014 Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes, a disease that affects approximately 30 million persons in the United States. DKA is more common among persons with type 1 diabetes. After a slight decline during 20002009, hospitalizations for DKA increased in the United States during 20092014 among all age groups and were highest among persons aged <45 years. Concurrently, in-hospital case-fatality rates among persons with DKA consistently decreased from 2000 to 2014. What are the implications for public health practice? DKA is a life-threatening but avoidable complication of diabetes. Prevention measures, such as diabetes self-management education, might help reverse the increasing trend in DKA, especially in persons aged <45 years who have the highest DKA rates. Diabetes is a common chronic condition and as of 2015, approximately 30 million persons in the United States had diabetes (23 million with diagnosed and 7 million with undiagnosed) (1). Diabetic ketoacidosis (DKA) is a life-threatening but preventable complication of diabetes characterized by unco Continue reading >>

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Popular Questions

  1. iammrhappy

    How to get deeper into Ketosis?

    I've been doing keto for about 2 weeks now. I want to get deeper into ketosis. I'm always on the moderate side when checkin with ketostix.
    My diet is simple
    Breakfast - 3 fried eggs with butter + shredded rotisserie chicken from costco + tapatio sauce
    Snacks - cheese, peanut/almond butter, silk almond milk
    Dinner - 2 hamburger patties grilled with my george forman grill. + cheese + lettuce to wrap it with.
    im hittin ~65/~30/~5 everyday. I lift 5 times a week.
    I'm thinking of adding cardio in everday. just 20 minutes of HIIT or MISS on a fasted stated in the morning.
    Any suggestions would be great. I want to lose fat. ASAP. The first week I lost ~8 pounds. But I know that all water weight. I want it to be fat weight.
    Thanks for your time.

  2. andymant

    As far as i am aware and correct me if i am wrong but the colour of the keto sticks doesnt indicate how deep you are in ketosis, if i drink a lot of water its pale pink and if i dont its darker.
    In answer to your question about deep ketosis, and again correct me if i am wrong please, its about time spent in ketosis and possibily the volume of fat consumed with fewer carbohydrates.
    As for losing fat ASAP i think you need to understand that its going to be a long game and its not a quick fix. 2 weeks is nothing, you wont even be fat adapted yet until that happens dont expect huge amounts of fat loss
    Why add cardio so soon, you have only just started, i honestly think you are being impatient here
    I would imagine someone like Lawrence and Alex would be able to give you some more sciency stuff behind this when they read this!

    Originally Posted by iammrhappy
    I've been doing keto for about 2 weeks now. I want to get deeper into ketosis. I'm always on the moderate side when checkin with ketostix.
    My diet is simple
    Breakfast - 3 fried eggs with butter + shredded rotisserie chicken from costco + tapatio sauce
    Snacks - cheese, peanut/almond butter, silk almond milk
    Dinner - 2 hamburger patties grilled with my george forman grill. + cheese + lettuce to wrap it with.
    im hittin ~65/~30/~5 everyday. I lift 5 times a week.
    I'm thinking of adding cardio in everday. just 20 minutes of HIIT or MISS on a fasted stated in the morning.
    Any suggestions would be great. I want to lose fat. ASAP. The first week I lost ~8 pounds. But I know that all water weight. I want it to be fat weight.
    Thanks for your time.

  3. iammrhappy

    Originally Posted by andymant
    As far as i am aware and correct me if i am wrong but the colour of the keto sticks doesnt indicate how deep you are in ketosis, if i drink a lot of water its pale pink and if i dont its darker.
    In answer to your question about deep ketosis, and again correct me if i am wrong please, its about time spent in ketosis and possibily the volume of fat consumed with fewer carbohydrates.
    As for losing fat ASAP i think you need to understand that its going to be a long game and its not a quick fix. 2 weeks is nothing, you wont even be fat adapted yet until that happens dont expect huge amounts of fat loss
    Why add cardio so soon, you have only just started, i honestly think you are being impatient here
    I would imagine someone like Lawrence and Alex would be able to give you some more sciency stuff behind this when they read this!

    True. I think the sticks are just an indicator of how much ketones are in my piss. Not of my body is using ketones.
    I don't feel any of the side effects of being in Ketosis. I know im in it though. I haven't eaten a carb in a while.
    I'm just starting cardio because I want to build up my cardiovascular system and for health. At what week should my body start shedding the weight?

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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

Professor of Pediatric Endocrinology University of Khartoum, Sudan Introduction DKA is a serious acute complications of Diabetes Mellitus. It carries significant risk of death and/or morbidity especially with delayed treatment. The prognosis of DKA is worse in the extremes of age, with a mortality rates of 5-10%. With the new advances of therapy, DKA mortality decreases to > 2%. Before discovery and use of Insulin (1922) the mortality was 100%. Epidemiology DKA is reported in 2-5% of known type 1 diabetic patients in industrialized countries, while it occurs in 35-40% of such patients in Africa. DKA at the time of first diagnosis of diabetes mellitus is reported in only 2-3% in western Europe, but is seen in 95% of diabetic children in Sudan. Similar results were reported from other African countries . Consequences The latter observation is annoying because it implies the following: The late diagnosis of type 1 diabetes in many developing countries particularly in Africa. The late presentation of DKA, which is associated with risk of morbidity & mortality Death of young children with DKA undiagnosed or wrongly diagnosed as malaria or meningitis. Pathophysiology Secondary to insulin Continue reading >>

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Popular Questions

  1. Emacfarland

    I'm confused about what defines being in nutritional ketosis based on blood levels. The Diet Doctor website says 1.5 is considered ketosis while I've heard on Keto Talk from Doc Nally that fit and active people can be in ketosis at levels of .3 or .4 and that higher levels don't necessarily mean better. So I'm not sure what the heck I'm aiming for! If I get readings below 1.5 am I doing something wrong? I am fit and active and Doc Nally has said this can make blood ketone level readings lower because an active persons body is using the ketones more efficiently. Should I be aiming for higher levels?

  2. BillJay

    It seems that the longer someone is keto-adapted, the more their body produces just the right amount of ketones and what we measure in the blood is only what's not actually being used, therefore it seems not only possible, but likely that people are in ketosis even with lower betahydroxybutyrate (BHB) levels - the ketone in the blood that these meters measure.
    This is somewhat frustrating for me since I'd like for there to be an objective measurement of being in ketosis, but that seems to be elusive.
    Therefore, a better indication is your level of carbs since it is HIGHLY unlikely that anything over 50 carbs is in ketosis and more likely that keeping carbs under 20 grams is a safe bet. Another indication is keeping protein at moderate levels which is 1.0 to 1.5 grams per kilogram of lean body weight.
    Once the macro-nutrients are in the proper range, I think that signs of keto-adapation are more poignant and below is a post from Mark Sisson on Dr. Mercola's site that explains many of the signs of being keto-adapted.

    What Does It Mean to Be Fat Adapted?
    543

  3. richard

    Dr Phinney invented the term so he gets to define it.
    In his book "The art and science of low carbohydrate living" he gives the range from 0.5 to 3.0 mmol/l
    But recently he mentioned that some of Dr Volek's very athletic subjects were clearly in ketosis at 0.2 mmol/l.
    My personal range is from 0.2 to 0.8 mmol/l, and I have been in ketosis for almost 3 years. Prof Tim Noakes is also normally in the same range 0.2-0.8.
    I suspect when we first start we aren't good at using them so we make too many and use too little so we end up with a lot left in our blood. After we become better adapted we end up in whatever physiological range our bodys feel best ensures our survival. And people who are trained and good fat burners may be able to get away with less because they can make it easily.
    When I fast for 3 days and then do 3 hours of exercise my ketones can go as high as 3.5. But I know people who regularly get up to 7.
    It's worth pointing out that Dr Nally has mentioned in his most recent podcast that he eats exogenous ketones 3 times a day. And he sells them.

    Personally I wouldn't be worried. I think you are doing fine.

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