Etiology Of Diabetic Ketoacidosis

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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: 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. derphamster

    Yes you were on the way to DKA, because you are not producing enough insulin to meet your body's needs whilst working out.
    You can go into DKA without your blood sugars being high if you have a mismatch in insulin requirement vs insulin output. The normal/low blood sugar DKA is quite rare but it can happen if the circumstances are right. You did the right thing to fight it, by having some carbs and protein and drinking a lot of water. If it repeats and you can't get the ketones down and you feel unwell you need to go to hospital. DKA can put you in a coma within hours so you need to take it seriously.
    I'd try to ease off doing hard workouts. You can still exercise but if this happens again you should rethink. You can also use this to back up your story at the doctors.

  2. joralo

    Thank you derphamster, you always give great advice in all of my threads. :) Now I'm even more scared....I feel even more wary of the oGTT now, I shouldn't take it if I react this badly. If I am on my way to DKA with just some exercise and not much food - how will I react when downing 75 g of glucose? Probably straight to DKA... I really don't know what to do, other than sit around and wait until I actually develop whatever form of diabetes I have - so that some doctor will finally help me out and take me seriously. Even if I took the oGTT - what if it's one of those rare unpredictable days where my body still handles it and at the 2nd hour it is < 200...I will be sent home as "glucose intolerant" and would still be none the wiser. This limbo state truly sucks, sorry had to vent.

  3. derphamster

    Don't worry, ogtt won't cause you to go into DKA. You'll still be making the same amount of insulin, which is obviously enough for normal activities (evidenced by your normal readings most of the time). DKA occurs not from high blood sugar, but from not having enough insulin for your needs. The reason you got ketones when you were exercising is that a workout drastically increases the body's need for insulin as there are hundreds of hungry muscles competing for fuel, which is delivered by insulin. When insulin can't keep up, the body must burn fat for fuel which generates ketones.
    I also forgot to mention that your lack of food (specifically, carbs) before your workout could also cause your body to produce more ketones due to not enough glucose. If you'll be doing something strenuous, consider having a 10-15g carb snack shortly beforehand.
    The high blood sugar normally associated with DKA is a result of too little insulin for the body's basic function, so even though a person is eating carbs, the sugar just stays in the blood and builds up to a high level. The high blood sugar is a symptom, not a cause.

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DKA diabetic ketoacidosis nursing management pathophysiology & treatment. DKA is a complication of diabetes mellitus and mainly affects type 1 diabetics. DKA management includes controlling hyperglycemia, ketosis, and acdidosis. Signs & Symptoms include polyuria, polydipsia, hyperglycemia greater than 300 mg/dL, Kussmaul breathing, acetone breath, and ketones in the urine. Typically DKA treatment includes: intravenous fluids, insulin therapy (IV regular insulin), and electrolyte replacement. This video details what the nurse needs to know for the NCLEX exam about diabetic ketoacidosis. I also touch on DKA vs HHS (diabetic ketoacidosis and hyperosmolar hyperglycemic nonketotic syndrome (please see the other video for more details). Quiz on DKA: http://www.registerednursern.com/diab... Lecture Notes for this video: http://www.registerednursern.com/diab... Diabetes NCLEX Review Videos: https://www.youtube.com/playlist?list... Subscribe: http://www.youtube.com/subscription_c... Nursing School Supplies: http://www.registerednursern.com/the-... Nursing Job Search: http://www.registerednursern.com/nurs... Visit our website RegisteredNurseRN.com for free quizzes, nursing care plans, salary information, job search, and much more: http://www.registerednursern.com Check out other Videos: https://www.youtube.com/user/Register... Popular Playlists: "NCLEX Study Strategies": https://www.youtube.com/playlist?list... "Fluid & Electrolytes Made So Easy": https://www.youtube.com/playlist?list... "Nursing Skills Videos": https://www.youtube.com/playlist?list... "Nursing School Study Tips": https://www.youtube.com/playlist?list... "Nursing School Tips & Questions": https://www.youtube.com/playlist?list... "Teaching Tutorials": https://www.youtube.com/playlist?list... "Types of Nursing Specialties": https://www.youtube.com/playlist?list... "Healthcare Salary Information": https://www.youtube.com/playlist?list... "New Nurse Tips": https://www.youtube.com/playlist?list... "Nursing Career Help": https://www.youtube.com/playlist?list... "EKG Teaching Tutorials": https://www.youtube.com/playlist?list... "Personality Types": https://www.youtube.com/playlist?list... "Dosage & Calculations for Nurses": https://www.youtube.com/playlist?list... "Diabetes Health Managment": https://www.youtube.com/playlist?list...

Diabetic Ketoacidosis (dka)

Tweet Diabetic ketoacidosis (DKA) is a dangerous complication faced by people with diabetes which happens when the body starts running out of insulin. DKA is most commonly associated with type 1 diabetes, however, people with type 2 diabetes that produce very little of their own insulin may also be affected. Ketoacidosis is a serious short term complication which can result in coma or even death if it is not treated quickly. Read about Diabetes and Ketones What is diabetic ketoacidosis? DKA occurs when the body has insufficient insulin to allow enough glucose to enter cells, and so the body switches to burning fatty acids and producing acidic ketone bodies. A high level of ketone bodies in the blood can cause particularly severe illness. Symptoms of DKA Diabetic ketoacidosis may itself be the symptom of undiagnosed type 1 diabetes. Typical symptoms of diabetic ketoacidosis include: Vomiting Dehydration An unusual smell on the breath –sometimes compared to the smell of pear drops Deep laboured breathing (called kussmaul breathing) or hyperventilation Rapid heartbeat Confusion and disorientation Symptoms of diabetic ketoacidosis usually evolve over a 24 hour period if blood glucose Continue reading >>

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  1. Ultimeaciax

    Why is Aldehyde more stable, thus more acidic and also is more reactive at the same time?

  2. h9i9j9

    Aldehydes have carbonyl groups at the end of a chain. This means that the carbon also has a hydrogen attached to it. The oxygen is very electronegative, so it "sucks" electron density away from the carbon hydrogen bond. This weakens the carbon hydrogen bond, making them acidic.
    Ketones have carbonyl groups in the middle of the chain. There is NO hydrogen attached to the carbon (of the carbonyl). Thus, when the electronegative oxygen draws electron density away from the carbon, the charge is drawen away over the 2 carbon-carbon bonds. These carbons might have hydrogens on them, but the electron density decrease is now spread out over many more carbon hydrogen bonds...making them not as weak and thus less acidic.
    Aldehydes' functional group is at the end of the chain making them more accessible for a reaction (such as a nucleophlic attack) as there are less electrons repelling the "attacker" (nucleophile) away.
    Ketones have two carbon chain, which mean more electron repelling, less chance of reaction to occur at given temperature.

  3. SN2ed

    Thread moved. These types of questions belong in Study Q&A forum.

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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.

What Causes Diabetic Ketoacidosis?

Living With Diabetes Starts With Proper Management As a type 1 diabetic I am quite familiar (unfortunately) with the signs and symptoms of diabetic ketoacidosis . Diabeticketoacidosis(DKA) results fromassociated with too little insulin (and usually high blood sugars as well)which leads to the product of organic acids calledketones. Diabetic ketoacidosis is associated with significant disturbances of the bodys chemistry, which resolve with proper therapy. (And lets clear up early that DKA andnutritional ketosis experienced in low-carb diets are two extremely different thingsbut more on that in a different article!) Diabeticketoacidosisusually occurs in people with type 1 diabetes mellitus, but diabetic ketoacidosis can develop in any person with diabetes. Sincetype 1 diabetestypically 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. People withtype 1 diabetesdo not have enoughinsulin, a hormone the body uses to break down sugar (glucose) in the blood for energy. When glucose is not available,fat is broken downinstead. As fats are broken down, acids calledketonesbuild up in the bl Continue reading >>

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  1. red2680

    I have been off Atkins for quite a while, and I restarted this week. I am finally feeling good today, however my daughter who is 18 wanted to lose a few pounds so she started with me. Just doing what I do, which is around 20ish carbs on induction. She has about 15 pounds she'd like to lose.
    Last night, which was day 3 for her she got very nauseated, and ended up throwing up. (FEeling a bit better today)
    I wondered if this passes, or is this WOE just NOT for her...
    I will help her add some carbs today, since I think that might help. Any insight might help on how to do this.

  2. Luzyanna

    If she 'carbed out' before starting it could have made it much worse. I remember my initial induction being pretty bad but the ones since not near as bad. Adding in a few more carbs for a day or two will probably help her...slowly wean back down.

  3. red2680

    Can you help me on what types of food to add carbs?
    Yeah she carbed out! And drank enough caffine that she is probably missing that, too. And I remember my first time being really really hard... but it is different when it's my CHILD! ;)

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