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Dka Uptodate

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Hyperglycemic crises: Hyperglycemic hyperosmolar nonketotic coma (HHNK) versus DKA. See DKA video here: https://youtu.be/r2tXTjb7EqU This video and similar images/videos are available for instant download licensing here https://www.alilamedicalmedia.com/-/g... Voice by: Penelope Hammet Alila Medical Media. All rights reserved. All images/videos by Alila Medical Media are for information purposes ONLY and are NOT intended to replace professional medical advice, diagnosis or treatment. Always seek the advice of a qualified healthcare provider with any questions you may have regarding a medical condition. Support us on Patreon and get FREE downloads and other great rewards: patreon.com/AlilaMedicalMedia Hyperosmolar hyperglycemic state, or HHS, is another ACUTE and life-threatening complication of diabetes mellitus. It develops slower than DKA, typically in the course of several days, but has a much higher mortality rate. Like DKA, HHS is triggered when diabetic patients suffer from ADDITIONAL physiologic stress such as infections, other illness, INadequate diabetic treatment or certain drugs. Similar to DKA, the RISE in COUNTER-regulatory hormones is the major culprit. These hormones stimulate FURTHER production and release of glucose into the blood, causing it to overflow into urine, resulting in excessive LOSS of water and electrolytes. The major DIFFERENCE between HHS and DKA is the ABSENCE of acidosis in HHS. This is because, unlike DKA, the level of insulin in HHS patients is HIGH enough to SUPPRESS lipolysis and hence ketogenesis. This explains why HHS occurs more often in type 2 diabetics, who have more or less normal level of circulating insulin. Reminder: type 2 diabetics DO produce insulin but their cells do NOT respond to insulin and therefore cannot use glucose. Because symptoms of acidosis are NOT present, development of HHS may go UNnoticed until blood glucose levels become EXTREMELY high. Severe dehydration results in INcreased concentrations of solutes in the blood, raising its osmolarity. HyPERosmotic blood plasma drives water OUT of bodys tissues causing cellular dysfunction. Primary symptom of HHS is ALTERED consciousness due to excessive dehydration of brain tissues. This can range from confusion to coma. Emergency treatment consists of intravenous fluid, insulin and potassium similar to those used in DKA.

Hyperglycemic Crises: Diabetic Ketoacidosis (dka), And Hyperglycemic Hyperosmolar State (hhs)

Go to: Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are acute metabolic complications of diabetes mellitus that can occur in patients with both type 1 and 2 diabetes mellitus. Timely diagnosis, comprehensive clinical and biochemical evaluation, and effective management is key to the successful resolution of DKA and HHS. Critical components of the hyperglycemic crises management include coordinating fluid resuscitation, insulin therapy, and electrolyte replacement along with the continuous patient monitoring using available laboratory tools to predict the resolution of the hyperglycemic crisis. Understanding and prompt awareness of potential of special situations such as DKA or HHS presentation in comatose state, possibility of mixed acid-base disorders obscuring the diagnosis of DKA, and risk of brain edema during the therapy are important to reduce the risks of complications without affecting recovery from hyperglycemic crisis. Identification of factors that precipitated DKA or HHS during the index hospitalization should help prevent subsequent episode of hyperglycemic crisis. For extensive review of all related areas of Endocrinology, visit WWW.ENDOTEXT. Continue reading >>

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  1. Santosh Anand

    Insulin plays a key role in helping sugar (glucose) enter your cells, thus providing them energy. When your cells don't get the glucose they need for energy, your body begins to burn fat for energy, which produces ketones. Ketones are acidic and so when they build up in the blood, they make the blood more acidic, leading to the condition called diabetic ketoacidosis (DKA).
    Now, in type-1 diabetes, there is no insulin production whereas in type-2, there is impairment of insulin production. Thus why Type-2 diabetic people hardly get DKA.
    Note: Diabetic ketoacidosis is a serious condition that might lead to diabetic coma or even death.

  2. Lucas Verhelst

    In order for the cells in your body to access the glucose in your bloodstream so they can use it as energy they need insulin. Insulin acts like a key, opennin the cell door to allow the entry of glucose. Type 1 diabetics produce no insulin and need to inject it, thus the amount of insulin they have is strictly limited. Once they run out of insulin the glucose remains in the blood stream. If this occurs over a long period of time their blood glucose levels will rise due to the release of glucose from the liver. High blood sugar levels causes ketoacidosis which leads to coma and death.

  3. Keith Phillips

    Although type 2 diabetics suffer from insulin resistance, the condition rarely has an absolute negative effect on the bodies ability to convert glucose to usable energy. Type 1 diabetics have little or no ability to produce insulin. With the exception of neural cells, the rest of the body which without insulin is experiencing starvation, will consume its own tissues. (this is how people have endured periods of famine). This process however produces by products that eventually overwhelm the body's ability to process toxins.

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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.....

Management Of Diabetic Ketoacidosis In Adults

Management of diabetic ketoacidosis in adults Management of diabetic ketoacidosis in adults Insulin (blue dots) promotes glucose uptake in the liver and muscles, controlling blood sugar. Feeding/transition to subcutaneous insulin The first mealtime after the acidosis has resolved and the patient feels that he or she can tolerate food is the time to begin feeding the patient. Subcutaneous insulin should be started simultaneously. Dosing of subcutaneous insulin is given in basal/bolus fashion calculated first as total daily dose (TDD), which is based on insulin therapy the patient received at home prior to losing control. Alternatively, TDD may be estimated at 0.5 to 0.8 units/kg/day in an individual who has not previously been treated with insulin.3 Total daily insulin requirements may be significantly elevated for a few days following the resolution of DKA due to persistently elevated counter-regulatory hormone concentrations. These elevations predispose the patient to going back into acidosis if insulin levels are inadequate or stress levels increase further. Basal/bolus insulin therapy is generally broken down into long- and short-acting insulin as 50% basal and 50% bolus spread Continue reading >>

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Popular Questions

  1. Santosh Anand

    Insulin plays a key role in helping sugar (glucose) enter your cells, thus providing them energy. When your cells don't get the glucose they need for energy, your body begins to burn fat for energy, which produces ketones. Ketones are acidic and so when they build up in the blood, they make the blood more acidic, leading to the condition called diabetic ketoacidosis (DKA).
    Now, in type-1 diabetes, there is no insulin production whereas in type-2, there is impairment of insulin production. Thus why Type-2 diabetic people hardly get DKA.
    Note: Diabetic ketoacidosis is a serious condition that might lead to diabetic coma or even death.

  2. Lucas Verhelst

    In order for the cells in your body to access the glucose in your bloodstream so they can use it as energy they need insulin. Insulin acts like a key, opennin the cell door to allow the entry of glucose. Type 1 diabetics produce no insulin and need to inject it, thus the amount of insulin they have is strictly limited. Once they run out of insulin the glucose remains in the blood stream. If this occurs over a long period of time their blood glucose levels will rise due to the release of glucose from the liver. High blood sugar levels causes ketoacidosis which leads to coma and death.

  3. Keith Phillips

    Although type 2 diabetics suffer from insulin resistance, the condition rarely has an absolute negative effect on the bodies ability to convert glucose to usable energy. Type 1 diabetics have little or no ability to produce insulin. With the exception of neural cells, the rest of the body which without insulin is experiencing starvation, will consume its own tissues. (this is how people have endured periods of famine). This process however produces by products that eventually overwhelm the body's ability to process toxins.

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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.

Management Of Adult Diabetic Ketoacidosis

Go to: Abstract Diabetic ketoacidosis (DKA) is a rare yet potentially fatal hyperglycemic crisis that can occur in patients with both type 1 and 2 diabetes mellitus. Due to its increasing incidence and economic impact related to the treatment and associated morbidity, effective management and prevention is key. Elements of management include making the appropriate diagnosis using current laboratory tools and clinical criteria and coordinating fluid resuscitation, insulin therapy, and electrolyte replacement through feedback obtained from timely patient monitoring and knowledge of resolution criteria. In addition, awareness of special populations such as patients with renal disease presenting with DKA is important. During the DKA therapy, complications may arise and appropriate strategies to prevent these complications are required. DKA prevention strategies including patient and provider education are important. This review aims to provide a brief overview of DKA from its pathophysiology to clinical presentation with in depth focus on up-to-date therapeutic management. Keywords: DKA treatment, insulin, prevention, ESKD Go to: Introduction In 2009, there were 140,000 hospitalization Continue reading >>

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  1. kimiko242

    So I've been doing some research on the Keto diet and so far it looks like a diet that can bring me the results I need, however I've never been on a diet before. Personally I don't believe in diets and usually watch what I eat on a regular basis but recently I realized that I needed some type of drive or diet to improve my metabolism.
    I used to be a huge athlete (volleyball, swimming, softball, dance) for as long as I could remember and stopped once I entered my 2nd year of college due to the heavy work load I was given from both work and school. Ever since then my weight fluctuated.
    So my questions are should I do the keto diet and if so will it effect my metabolism and what should I watch out for while doing this diet?

  2. hornwort

    I wouldn't even call it a "diet", really. It's more of a nutritional system, living life without the inefficient sugars that cause us to operate day-to-day in a series of crashes.
    It will massively transform your metabolism, because your body will start using all the calories you give it for fuel, instead of directing them into fat storage to avoid spiking your blood sugar. Insulin is what makes us fat, because without it, sugar would kill us. From a biological and evolutionary point of view, the only capacity our bodies have to even deal with carbs is as a last-resort for calories, to prevent starvation.
    I have led an active lifestyle and eaten healthy my entire life, and while I've always been "healthy", that is, able to outmatch people who look far fitter than me in running, strength, agility and etc., I've been overweight my entire life. To expand and elaborate, I have eaten less calories, less processed food, while being far more active than friends and family you would call "thin" or "fit", and the only time I have ever been able to lose weight is during times of unemployment where I can work out for 6-8 hours per day while eating nothing but a steamed chicken breast and spinach/celergy/arugala each day.
    Now, on Keto, I see the fat melting off, I have far more energy, I enjoy food more and cook more elaborately, my moods are better, and even my concentration is better.
    Now for the cons:

    The induction period is hard for some people. You have to really plan ahead, using calorie and cabohydrate calculators (myfitnesspal.com is a godsend). Google "fat bombs" and think about investing in a carb-free protein powder -- these make it extremely easy to hit your fat and protein percentages (65% and 30% of calorie intake, if you're muscled). You will likely experience some digestive issues while your body gets used to it, and some experience temporary loss of energy and/or lightheadedness during the induction phase. Some people find they get bad breath in the beginning -- this can be due either to having too much protein and not enough fat, or dehydration.

    And speaking of dehydration. Because carbs are what causes our body to store water, you will find yourself drinking A LOT without them. They say we should drink 8 glasses a day? Try 30, on keto. Minimum. This is probably the most dangerous part of keto. And obviously, this also means killer hangovers. Be sure to drink a minimum of one glass of water between drinks. I drink gin and soda with lime a lot, to offset this a bit... but it's still the biggest "con" of keto for me, as a very social person and historically heavy drinker.

    You will also have to be very careful about nutrition -- without fruit and with such limited carb intake, it's very easy to get low on things like potassium, magnesium and vitamin C. So take a multivitamin, get some carb-free electrolyte powder, and make sure to eat a lot of broccoli/asparagus/cauliflower/spinach/arugala. Those are the 5 staple veggies to rely on for nutrition.

    You will likely experience massive cravings for carbs and sugar. For me this happened about a week after I started keto, and lasted for about a week. I had higher calorie intake as a result, trying to stave off those cravings -- feelings like I would murder just for a slice of sourdough. I still managed a minimum daily deficit of 300 though, with the help of my two favourite indulgences: good liquor and cigars (carb free).

    You will find it harder to build muscle on keto. I did primal for a month before starting to build it up, but there's been a noticeable (though not huge) drop in the rate at which I increase weight in my resistance workouts. This is mainly due to the fact that carbs help with the absorption of protein into muscle, whereas fat slows it down. The best remedy I've found is to have a few carbs immediately after a workout - oats are best.
    If you can live with those, keto may be for you. It's certainly not for everyone. But if you're up to the challenge of induction, it will change your life in very positive ways. Even the first few days without carbs, it's like a curtain of fog peels away, and you realize what "energy" really is. I remember when it occurred to me that I hadn't yawned in a week -- it was a joyous fuckin' realization.

  3. HuntTheShunt

    A high carbohydrate diet increases the demands of vitamin C because carbohydrate consumption hinders Vitamin C absorption.
    It's why sailors got scurvy but the Inuit did not, despite neither consuming Vitamin C rich food. Sailors had a higher percentage of their diet from carbohydrates, meanwhile the small levels of Vitamin C available from animal sources was sufficient to keep the Inuit healthy on their low carbohydrate diets.
    Still, eat your green veggies as you said.

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