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Euglycemic Diabetic Ketoacidosis Treatment

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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.....

Euglycemic Diabetic Ketoacidosis: A Review

Euglycemic Diabetic Ketoacidosis: A Review Author(s): Anar Modi , Department of Endocrinology, Diabetes & Metabolism, Cooper University Hospital, Camden, New Jersey, United States Abhinav Agrawal* , Department of Medicine, Monmouth Medical Center, 300 Second Avenue, Long Branch, New Jersey, United States Farah Morgan . Department of Endocrinology, Diabetes & Metabolism, Cooper University Hospital, Camden, New Jersey, United States Introduction: Diabetic ketoacidosis (DKA) is one of the most serious complications of diabetes.It is characterised by the triad of hyperglycemia (blood sugar >250 mg/dl), metabolic acidosis(arterial pH <7.3 and serum bicarbonate <18 mEq/L) and ketosis. Rarely these patients can present withblood glucose (BG) levels of less than 200 mg/dl, which is defined as euglycemic DKA. The possibleetiology of euglycemic DKA includes the recent use of insulin, decreased caloric intake, heavy alcoholconsumption, chronic liver disease and glycogen storage disorders. DKA in pregnancy has also beenreported to present with euglycemia. The recent use of sodium glucose cotransporter 2 (SGLT2) inhibitorshas shed light on another possible mechanism of euglycemic DKA. Clinicia Continue reading >>

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  1. hippocampus

    What are the potassium level abnormalities associated with DKA (during diagnosis and treatment.)

  2. ahassan

    During DKA, the total body K is low bcz of osmotic diuresis, BUT the serum k conc. is raised bcz of the lack of insulin action, which allows k to shift out of the cells. So hyperkalemia.
    During treatment, k is shifted into the cells, which may lead to profound hypokalemia n death if not treated, so during therapy you have to adjust KCL conc. depending on blood K levels.

  3. tomymajor

    In DKA--> K level may be high or normal so we dont add k from the start of ttt
    But : In HHNKC---> K level is low from the start so we give k from start of ttt

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Euglycemic Diabetic Ketoacidosis In Type 2 Diabetes Treated With A Sodium-glucose Cotransporter-2 Inhibitor

Go to: Case A 51-year-old man with a known history of T2DM and hypertension presented to the emergency department with a 1-week history of malaise, cough, and intermittent shortness of breath. Over the preceding 2 days, he admitted to a history of decreased oral intake and fever, and he had abstained from taking his antihyperglycemic medications (canagliflozin and linagliptin-metformin). He reported 3 episodes of clear emesis the day of his presentation in the emergency department. He denied any other symptoms, sick contacts, or travel history. He reported no substance use, alcohol consumption, or other ingestions. He was not vaccinated against the flu. He was not taking insulin. Vital signs at triage were within normal limits except for a heart rate of 122 beats/min. The patient looked well and was in no acute distress. The only relevant physical examination findings were mild inspiratory crackles at the left lower lobe on auscultation of the lungs. A 12-lead electrocardiogram showed sinus tachycardia at 101 beats/min. Initial bloodwork revealed a hemoglobin level of 159 g/L (normal range 130 to 170 g/L); a white blood cell count of 12.1 × 109/L (normal range 4.8 × 109/L to 10.8 Continue reading >>

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  1. Nathaniel66

    I've been on keto for over 1.5 year. About once every month i'm hosting / visiting our customers/ suppliers and then there's usually plenty of food (whole day, or 1 looong lasting feast. Lots of carbs!
    Every morning after day like this i have keto breath + this specific urine smell. The next day all is gone.
    What's going on? Morning after carbs up ketones are not used, therefore body is getting rid of them (breath + urine smell), and the nex day when carbs are burned up i use my ketones again and so no more dragon breath/ urine smell- i'm back on keto?

  2. superdogfarm

    You could be right. Also could be from burning your fat stores.

  3. JonBanaitis

    since you are eating carbs your body is getting rid of the ketones through urin and breath because its burning sugar , this is why your getting the smell you no longer need ketons with sugar in the blood stream so I will release the remaining ketones to use sugar up

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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...

Dka That Wasn't: A Case Of Euglycemic Diabetic Ketoacidosis Due To Empagliflozin | Oxford Medical Case Reports | Oxford Academic

Sodium glucose co-transporter (SGLT-2) inhibitor is a relatively new medication used to treat diabetes. At present, the Food and Drug Administration (FDA) has only approved three medications (canagliflozin, dapagliflozin and empagliflozin) in this drug class for the management of Type 2 diabetes. In May 2015, the FDA issued a warning of ketoacidosis with use of this drug class. Risk factors for the development of ketoacidosis among patients who take SGLT-2 inhibitors include decrease carbohydrate intake/starvation, acute illness and decrease in insulin dose. When identified, immediate cessation of the medication and administration of glucose must be done, and in some instances, starting an insulin drip might be necessary. We present a case of a patient with diabetes mellitus being on empagliflozin (SGLT-2 antagonist) who was admitted for acute cholecystitis. The hospital course was complicated by euglycemic diabetic ketoacidosis after being kept nothing per orem before a contemplated cholecystectomy. The management of diabetes has evolved since its discovery in 1910. A gamut of medications has become available to address the glycemic control among diabetics especially for Type 2 d Continue reading >>

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  1. kris90

    Non Diabetic Ketoacidosis?

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  2. kris90

    I had been trying to correct what I believe to be small intestinal bacterial overgrowth (something I believe I have suffered from for years) with a ketogenic diet which has given me success in the past. My symptoms included: abdominal cramping/distention, bloating, gas (very foul), constipation, fatigue, and intense sugar cravings. I am otherwise very healthy (26 years old, 5'8 @ 160 lbs approx 8% bodyfat and active).
    This time around, I decided to follow a more strict ketogenic diet (one that is epi-paleo). I ate lots of salmon, mussels, grassfed beef, eggs, grass fed butter, coconut oil, occasional mixed nuts and almond butter. After a few days to a week in, I noticed more severe symptoms: nausea, racing heart, and spiking random fevers with chills after eating and worsening constipation & bloating let alone major headaches. I ended up checking in to the ER, and was given lactulose to help with constipation. It worked, and my bloating was gone, but still didn't feel right. I went back for some bloodwork, and everything came back normal (I can post results) blood glucose was 4.5 mmol/L. I noticed I would feel ok if I fasted, but as soon as I ate the high-fat keto meal, within an hour I'd spike a fever, and get major nausea and chills. I literally felt poisoned. I decided to check my urinary ketone levels using ketostix, and came back around 8 mmol/L. I was a little concerned given that on the pamphlet that a doctor should be contacted with a reading over 4 mmol/L. I thought perhaps my ketones were too high, so I decided to take in around 50g of carbs to see if that would bring me down. Bad idea. Nausea hit harder than ever and I was over the toilet thought I was dying (everything spinning, vision was fading out, body went numb and tingly, I was slowly drifting away). I had to get my wife to call 911, and luckily before they arrived, I snapped out of it, but had a mild fever and sweats and was shooken up.
    Paramedics said everything was fine, blood pressure a little high but normal with the stress. Also blood glucose was at 8 mmol/L. Decided to have them take me in. Had ketones checked at hospital and read 6 mmol/L, and blood glucose went up to 8.2 mmol/L. They monitored me for a few hours, and blood glucose dropped back to normal by early morning (4.0 mmol/L) and ketones slowly fell as well.
    The next day, I consumed a well balanced diet with carbs (avoiding refined/sugary carbs) and brought myself out of ketosis. All my symptoms went away and I felt better (other than feeling exhausted). Now today (a day later) I continued the well balanced diet, only now all my "pre-keto" symptoms reappeared (major foul gas, bloating, and constipation).
    Can anyone make any sense of this madness? Was this maybe a bad case of "die-off" symptoms? Or could my ketone level have caused me to feel "poisoned"? I wonder why my levels climbed so high since I am not a diabetic. I found a case of "non-diabetic ketoacidosis" which describes my case almost identically: http://www.empr.com/case-studies/a-...betic-patient-whats-the-cause/article/443559/
    Need suggestions on how to combat these GI issues/bacterial overgrowth now. Perhaps a non-keto/low carb diet (100g per day)?

  3. Jenelle

    I have had great success with a low-FODMAP approach. When I eliminate most of the foods that are high in FODMAPs, I experience almost zero digestive distress. If you haven't heard of this ~ definitely worth a Google.

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