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Dka Treatment Protocol

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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 (DKA) is a potentially life-threatening complication of diabetes mellitus.[1] Signs and symptoms may include vomiting, abdominal pain, deep gasping breathing, increased urination, weakness, confusion, and occasionally loss of consciousness.[1] A person's breath may develop a specific smell.[1] Onset of symptoms is usually rapid.[1] In some cases people may not realize they previously had diabetes.[1] DKA happens most often in those with type 1 diabetes, but can also occur in those with other types of diabetes under certain circumstances.[1] Triggers may include infection, not taking insulin correctly, stroke, and certain medications such as steroids.[1] DKA results from a shortage of insulin; in response the body switches to burning fatty acids which produces acidic ketone bodies.[3] DKA is typically diagnosed when testing finds high blood sugar, low blood pH, and ketoacids in either the blood or urine.[1] The primary treatment of DKA is with intravenous fluids and insulin.[1] Depending on the severity, insulin may be given intravenously or by injection under the skin.[3] Usually potassium is also needed to prevent the development of low blood potassium.[1] Th Continue reading >>

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  1. Kodah007

    I'm new here and may be too late for this discussion. Our 8 year old husky was in diabetic ketoacidosis 4 days ago. 3 nights on fluid at vet, started insulin, steroids and pain meds. She cannot walk on her own, like her hind legs are totally numb. She's also been going potty on herself at vet. I'm really worried she won't get better and I don't have the time to be carrying her around and/or cleaning up messes. How long can I expect this yo last? Do all dogs recover?

  2. k9diabetes

    Hi,
    I decided to copy your question to a thread of your own... so sorry such a scary experience brings you here.
    If she can get past the ketoacidosis, whatever leg problems and incontinence coming from neuropathy should gradually diminish with better blood sugar.
    Most dogs I've seen have fully recovered from neuropathy. Sometimes a dog has other spinal issues also involved and in those cases the problems associated with neuropathy go away so things get better.
    So, yes, chances are very good she can get back to normal. Beaming her Get Well wishes.... hang in there.
    Natalie

  3. Rubytuesday

    Hi there,
    If the sole cause of weakness in the backend is diabetic neuropathy, and it could well be, they can recover and go on to be healthy diabetics. Surviving diabetic ketoacidosis can take quite a toll on them and I would not judge her condition now as long as she isn't suffering. weakness isn't a lot of fun for either of you but they can get back to normal.
    I will attach some info about a key role a specific form of B-12 (methylcobalimin) plays in recovery.
    Many dogs here have struggled with hind end weakness. Has the B-12 helped in these cases? I don't know, but it hasn't hurt.
    The single most important thing you can do now is to find the best dose to manage her diabetes. This can be a trying process. To tell the truth this was the best place I found for getting the best information about how to go about that. My dog wasn't an easy diabetic and frankly my vets didn't know what to do to make our situation better. Folks here helped us tremendously. The collective knowledge and creativity was a godsend.
    I found that I couldn't rely on just the guidance from my vet and some stories I have heard have been downright scary. The best advice I can give is read a lot from the home page and threads, ask a bunch of questions and if at all possible give home testing a try. Doing your own home testing not only saves you money and keeps your dog safe, but it will help you progess through the regulation process a bit quicker.
    I will go grab the home page link for you and the b-12 info. Just don't want to lose this post. The ipad sometimes doesn't like me switching around.
    Tara
    ____________

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Diagnosis Coding When You Can and Cannot Code the Diagnosis http://www.cco.us/medical-terminology... One of the questions that we get from new students is knowing when you can and cannot code the diagnosis. I think a lot of students, as soon as they learn how to look up codes, they are ready to code everything that they see. And every new student does it. I remember I did it. I wanted to call myself a supercoder because I wanted to code everything. It's fun to code. But you can't do that. You need to code only definitive diagnoses and they can be hard to identify. One of the things that you have to stay away from is equivocal language. When we say equivocal language, that means it's kind of on the fence. It's not a definite. It can go one way or the other. You have to stay away from that type of verbiage. Impending or threatened conditions, you'll see that, but that can be tricky. You cannot code something if it has not happened yet, in most cases. Now I know that sounds again, a little ambiguous, but if your physician documents, for example, we'll scroll down here just a bit... impending rupture of spleen due to enlarged spleen. Okay, impending tells you it's going to happen. They're pretty sure it's going to happen but it hasn't happened yet. So you cannot code a ruptured spleen. You can only code the splenomegaly which is an enlarged spleen, 789.2. That's the proper code to use. Now I've got some more examples for you, so we'll scroll down and look at some of these others. Okay if your physician documents something like this -- Mrs. Jones is seen today with lower abdominal pain and spotting. I will admit her for a threatened miscarriage. So you're now saying to yourself, "Well, she hasn't had a miscarriage. It hasn't happened yet." But in actuality, there's a code for this because it's such a common event. You can, however, code 640.0 and you'll need a fifth digit. It does not matter that the miscarriage has not occurred yet. There is a code for a threatened miscarriage because that is a medical condition. If there had not been a code for that then you would have to code the signs and symptoms, just the spotting and the abdominal pain. Okay, we've got some more things to look at here, words that you want to pay attention to. "Possible, maybe, suspect, rule out, probable, expect, apparent, perhaps, conceivably, plausibly". Now if you're coding and you're coding in an office that you have repetitious documents from specific doctors and you see them all the time, you'll learn what verbiage they use. But if you're doing something like remote coding or multiple physicians, it may be a little harder and you have to kind of get to know how they like to document, how they like to word things. These are some words that just popped up in one day of remote coding that I was doing and it gets to be kind of humorous sometimes where you have to do a second take and say, "What did they say? They said maybe?" So scroll down just a little bit more. I've got some more examples. Okay, these terms mean your physician does not know or is waiting for more testing. If the statement is made, this is another little case -- Mr. Green has been feeling tired, thirsty and is making frequent trips to the bathroom. It's apparent he has DM since his father and mother both had DM by age 50. We will draw labs today. He is to return in one week for the results. Now, the fact that he said it's apparent he has diabetes, he didn't actually say that he has diabetes. He said it's apparent that he has diabetes. And then he confirms that he's not sure because he's going to do a test and have him come back for the results. You have to be very careful. If you gave this gentleman diabetes with the way you coded, it's going to follow him for the rest of his life. And he could have problems in the future, maybe even getting jobs or life insurance policies because they do look at your medical information to determine stuff like that. So you have to be very, very careful. He might just have a bad cold and be real thirsty. Get more medical coding training,, medical coding tutorial, medical coding tips, medical coding certification, and free medical coding webinars at http://www.cco.us/cco-yt https://youtu.be/yMGz3ctOKaA

Diagnosis

Print If your doctor suspects diabetic ketoacidosis, he or she will do a physical exam and various blood tests. In some cases, additional tests may be needed to help determine what triggered the diabetic ketoacidosis. Blood tests Blood tests used in the diagnosis of diabetic ketoacidosis will measure: Blood sugar level. If there isn't enough insulin in your body to allow sugar to enter your cells, your blood sugar level will rise (hyperglycemia). As your body breaks down fat and protein for energy, your blood sugar level will continue to rise. Ketone level. When your body breaks down fat and protein for energy, acids known as ketones enter your bloodstream. Blood acidity. If you have excess ketones in your blood, your blood will become acidic (acidosis). This can alter the normal function of organs throughout your body. Additional tests Your doctor may order tests to identify underlying health problems that might have contributed to diabetic ketoacidosis and to check for complications. Tests might include: Blood electrolyte tests Urinalysis Chest X-ray A recording of the electrical activity of the heart (electrocardiogram) Treatment If you're diagnosed with diabetic ketoacidosis, y Continue reading >>

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  1. Fry

    To my knowledge this has been demonstrated in mice. Mice that were not necessarily fed a healthy diet and that are mice and not as likely to eat that kind of diet like humans are in nature, for the past hundred thousand years.
    However of all the studies in humans, while there have been some negative ones showing arterial stiffness or other issues, there have been none, that I know of, showing the diet to cause insulin resistance and several that showed increased insulin sensitivity.
    I have read that while in ketosis one will develop insulin resistance but it is a temporary and necessary response by your body to ensure that your brain gets enough glucose and, most importantly, that this resistance is completely reversible and sensitivity will go back up if/when one started eating carbs again.

    Does anyone know? Studies? Science?

  2. brownfat

    Blood glucose tracking can give a good sense of changing insulin resistance. If over time on the diet your fasted bg is falling and/or your post prandial bg rise to a particular food diminishes then you are likely becoming more insulin sensitive. Fasting should help.

  3. VLC.MD

    A foundational principle of low carb diets is that they lower insulin resistance in humans.

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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: Evaluation And Treatment

Diabetic ketoacidosis is characterized by a serum glucose level greater than 250 mg per dL, a pH less than 7.3, a serum bicarbonate level less than 18 mEq per L, an elevated serum ketone level, and dehydration. Insulin deficiency is the main precipitating factor. Diabetic ketoacidosis can occur in persons of all ages, with 14 percent of cases occurring in persons older than 70 years, 23 percent in persons 51 to 70 years of age, 27 percent in persons 30 to 50 years of age, and 36 percent in persons younger than 30 years. The case fatality rate is 1 to 5 percent. About one-third of all cases are in persons without a history of diabetes mellitus. Common symptoms include polyuria with polydipsia (98 percent), weight loss (81 percent), fatigue (62 percent), dyspnea (57 percent), vomiting (46 percent), preceding febrile illness (40 percent), abdominal pain (32 percent), and polyphagia (23 percent). Measurement of A1C, blood urea nitrogen, creatinine, serum glucose, electrolytes, pH, and serum ketones; complete blood count; urinalysis; electrocardiography; and calculation of anion gap and osmolar gap can differentiate diabetic ketoacidosis from hyperosmolar hyperglycemic state, gastroente Continue reading >>

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  1. DJ72

    Anybody else get them?
    I am going to be 41 in May and too young for this stuff. LOL My TOM has been good but started having hot flashes last week. They don't last long but are annoying.
    Hair loss and hot flashes. THIS IS FUN!
    But I am now officiallly 30 lbs lighter and will suck it up for the next 16 lbs!

  2. leannekarella

    Quote:

    Originally Posted by DJ72
    Anybody else get them?
    I am going to be 41 in May and too young for this stuff. LOL My TOM has been good but started having hot flashes last week. They don't last long but are annoying.
    Hair loss and hot flashes. THIS IS FUN!
    But I am now officiallly 30 lbs lighter and will suck it up for the next 16 lbs! Yes. I get them. Usually right after I eat my protein. It's like the fire burns hot for a bit right after I eat.
    But then I have very cold times too. Sleep with socks on now, and never ever did in my life.

  3. DJ72

    Hey Leanne! My flashes just happen whenever! But I hear ya about the cold thing too! Grrr

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