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Fruity Breath Odor Hyperglycemia

Drunk Versus Diabetes: How Can You Tell?

Drunk Versus Diabetes: How Can You Tell?

Dispatch calls your EMS unit to the side of a roadway, where police officers have detained a driver on suspicion of driving under the influence of alcohol intoxication. You find the female driver handcuffed in the back seat of a police cruiser. She is screaming profanities and hitting her head against the side window. An officer tells you that she was weaving in and out of traffic at highway speed, and it took several minutes to pull her over. She was noncooperative and it took several officers to subdue her. She sustained a laceration to her head, which the officers want you to evaluate. The woman continues to swear at you as you open the car door. You note that she is diaphoretic and breathing heavily. You can smell what appears to be the sour, boozy smell of alcohol, even though you are not close to her. You can see that the small laceration near the hairline on her right forehead has already stopped bleeding. Her speech is slurred and she appears to be in no mood to be evaluated. The police officers are ready to take her down to the station to be processed for driving under the influence. Sound familiar? It should — this is a scene that is played out often in EMS systems. While it may seem initially that these incidents are not medical in nature, they really deserve close attention by the EMS personnel. In this article we will focus on the challenges of evaluating a patient who is intoxicated versus a patient who is experiencing an acute diabetic emergency. There have been numerous instances where EMS providers have exposed themselves to serious liability secondary to medical negligence. Let's take a closer look. Diabetes Diabetes is a serious disease that affects nearly 29 million people in the United States [1]. Advances in diabetic care have resulted in an impr Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Diabetic Ketoacidosis Definition Diabetic ketoacidosis is a dangerous complication of diabetes mellitus in which the chemical balance of the body becomes far too acidic. Description Diabetic ketoacidosis (DKA) always results from a severe insulin deficiency. Insulin is the hormone secreted by the body to lower the blood sugar levels when they become too high. Diabetes mellitus is the disease resulting from the inability of the body to produce or respond properly to insulin, required by the body to convert glucose to energy. In childhood diabetes, DKA complications represent the leading cause of death, mostly due to the accumulation of abnormally large amounts of fluid in the brain (cerebral edema). DKA combines three major features: hyperglycemia, meaning excessively high blood sugar kevels; hyperketonemia, meaning an overproduction of ketones by the body; and acidosis, meaning that the blood has become too acidic. Insulin deficiency is responsible for all three conditions: the body glucose goes largely unused since most cells are unable to transport glucose into the cell without the presence of insulin; this condition makes the body use stored fat as an alternative source instead of the unavailable glucose for energy, a process that produces acidic ketones, which build up because they require insulin to be broken down. The presence of excess ketones in the bloodstream in turn causes the blood to become more acidic than the body tissues, which creates a toxic condition. Causes and symptoms DKA is most commonly seen in individuals with type I diabetes, under 19 years of age and is usually caused by the interruption of their insulin treatment or by acute infection or trauma. A small number of people with type II diabetes also experience ketoacidosis, but this is rare give Continue reading >>

Jaime Moo-young, Md

Jaime Moo-young, Md

Diabetic Ketoacidosis (DKA) Pathogenesis · Insufficient insulin for a given carbohydrate load decreased cellular metabolism of glucose · Increased gluconeogenesis, glycogenolysisHyperglycemia · Increased breakdown of free fatty acids as alternative energy source ketone and ketoacid accumulation · Hyperglycemiaserum hyperosmolality osmotic diuresis dehydration and electrolyte derangements (dehydration is most lethal!) · Seen almost exclusively in Type I diabetes; rarely in Type II Definition: Triad of 1. Hyperglycemia (usually between 500 – 800 mg/dL or 27.8-44.4 mmol/L) 2. Anion Gap Metabolic Acidosis (pH usually <7.30) 3. Ketonemia: -hydroxybutyrate, acetoacetate most significant ** Urine ketones do not make the diagnosis, but they can support it** Triggers (the “I’sâ€): Don’t forget to ask about these! · Insulin deficiency: insulin non-compliance, insufficient insulin dosing, new-onset Type I diabetes · Iatrognic: glucocorticoids, atypical antipsychotics, high-dose thiazide diuretics · Infection: UTI, pneumonia, TB · Inflammation: pancreatitis, cholecystitis · Ischemia/infarction: MI, stroke, gut ischemia · Intoxication: Alcohol, cocaine, other drugs Presentation · Symptoms · Polyuria, polydipsia, weight loss · Nausea, vomiting, abdominal pain · Fatigue, malaise · Associated trigger sx (fever/chills, chest pain, etc) · Signs · Volume depletion: skin turgor, dry axillae, dry mucus membranes, HR, BP · Altered mental status: stupor, coma · Kussmaul respirations: rapid, shallow breathing = hyperventilation to counteract metabolic acidosis · Fruity, acetone odor on breath Lab workup and findings · Hyperglycemia: > 250 mg/dL in serum, + glucose on urinalysis · Acidemia (pH <7. Continue reading >>

Fruity Odor On Breath, Metallic Taste In Mouth And Unusual Taste In Mouth

Fruity Odor On Breath, Metallic Taste In Mouth And Unusual Taste In Mouth

WebMD Symptom Checker helps you find the most common medical conditions indicated by the symptoms fruity odor on breath, metallic taste in mouth and unusual taste in mouth including Diabetic ketoacidosis, Medication reaction or side-effect, and Diabetes, type 1. There are 5 conditions associated with fruity odor on breath, metallic taste in mouth and unusual taste in mouth. The links below will provide you with more detailed information on these medical conditions from the WebMD Symptom Checker and help provide a better understanding of causes and treatment of these related conditions. Diabetic ketoacidosis Symptoms of diabetic ketoacidosis include dry mouth, excessive thirst and urination, and more. Medication reaction or side-effect Medication side effects include nausea, vomiting, stomach upset, weakness, dizziness, seizures, and more. Diabetes, type 1 Diabetes can make you feel hungry, tired, or thirsty; you may urinate more than normal and have blurry vision. Antibiotic use Antibiotics can cause stomach pain, diarrhea, nausea, vomiting, itching, rashes and dizziness. Poisoning Poisoning can cause nausea, vomiting, drooling, dry mouth, changes in pupil size, and more. Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

As fat is broken down, acids called ketones build up in the blood and urine. In high levels, ketones are poisonous. This condition is known as ketoacidosis. Diabetic ketoacidosis (DKA) is sometimes the first sign of type 1 diabetes in people who have not yet been diagnosed. It can also occur in someone who has already been diagnosed with type 1 diabetes. Infection, injury, a serious illness, missing doses of insulin shots, or surgery can lead to DKA in people with type 1 diabetes. People with type 2 diabetes can also develop DKA, but it is less common. It is usually triggered by uncontrolled blood sugar, missing doses of medicines, or a severe illness. Continue reading >>

Diabetic Emergencies – Hyperglycemia

Diabetic Emergencies – Hyperglycemia

Hyperglycemia - Quick and Dirty Root: Hyper-excessive, Glyc - sweet, Emia - blood Hyperglycemia is high blood sugar. It takes a while to progress and is accompanied by excessive urination and thirst. Symptoms don't usually start until over 250mg/dL, but a chronic blood glucose of 125mg/dL can damage organs over time. Insulin dependent diabetics (Type I) take insulin to help metabolize their blood glucose. When they do not take their insulin, that blood glucose builds up in the plasma. It can become a serious situation when the body has no insulin to move glucose and starts burning fat for energy, creating a waste product called ketones. They build up in the bloodstream and create an acidic blood state called ketoacidosis, which can be life threatening. Symptoms Altered mental status Abdominal cramps Nausea and vomiting Kussmaul respiration (Deep and Rapid) Acetone or fruity breath odor Questions to ask Are you a diabetic? Do you take insulin? Did you have it today? When was insulin last taken? Example Treatment Protocol - Short:O2, IV, Monitor, Fluid bolus, Zofran (over 300 in non-diabetic, or over 400 in diabetic patient with symptoms) • Establish IV NS and administer 500cc bolus • If patient is vomiting consider Zofran, 4mg IV/IM • Administer oxygen as needed and provide cardiac monitoring • May repeat NS 500cc bolus. • Transport in position of comfort, to avoid further nausea, vomiting, and aspiration. Continue reading >>

High Blood Sugar: Causes, Warning Signs And Treatment

High Blood Sugar: Causes, Warning Signs And Treatment

High blood sugar, or hyperglycemia, occurs when the body has too much food or glucose, or too little insulin. Potential reasons a person with type 1 diabetes (T1D) might have high blood sugar include: Not enough insulin taken Eating more than usual Eating earlier than usual Eating food with higher glucose content without injecting extra insulin Injecting insulin at a site on the body where the absorption rate is slower Missing or skipping an insulin dose A clog in insulin pump tubing Less exercise than normal Emotional or physical stress Illness or injury Other hormones Medications (such as steroids) Pain Hyperglycemia Symptoms Thirst (dehydration) Frequent urination, including potential waking up in the middle of the night to urinate; and unusually wet diapers in an infant or toddler. Blurry vision Stomach pain Increased hunger Nausea Drowsiness, lethargy, exhaustion Confusion Sweating Fruity, sweet or wine-like odor on breath Vomiting Inability to concentrate Weight loss (a longer-term symptom) that eventually leads to coma Treatments The following recommendations are general treatments for high blood sugar. Specific actions, such as giving additional insulin, should be determined by the adult with T1D, physician or parents (for a child). If blood test results are slightly above normal: Continue regular activity Drink water or sugar-free drinks Monitor blood-sugar levels by checking regularly Chart blood-glucose test results Consider injecting additional insulin as instructed by physician or parent If blood test results are moderately high: Don’t engage in strenuous exercise Drink water or sugar-free drinks Inject additional insulin if instructed by physician or parents Monitor blood-sugar levels by checking regularly Chart blood-glucose test results Try to discover Continue reading >>

Hyperglycemia And What To Do About It

Hyperglycemia And What To Do About It

This CE activity is approved by EMS World Magazine, an organization accredited by the Continuing Education Coordinating Board for Emergency Medical Services (CECBEMS) for 1 CEU. To take the CE test that accompanies this article, go to www.rapidce.com to take the test and immediately receive your CE credit. Questions? E-mail [email protected] Both hypoglycemia and hyperglycemia are true medical emergencies. As we discussed last month, hypoglycemia often has a rapid onset and can impact any patient whose body is not provided an adequate glucose supply. While anyone can experience hypoglycemia, it is most common in patients who have been diagnosed with diabetes and whose natural insulin does not function normally. Patients with diabetes also risk developing hyperglycemia, a complex and dangerous metabolic derangement that can be fatal without proper care. The American Diabetes Association says that in 2011 there were a staggering 25 million patients with diabetes and 79 million with pre-diabetes across the United States. This month’s CE article explores the consequences of hyperglycemia on the body and the life-threatening emergencies it can cause. Diabetic Disease Progression Recall that insulin secretion is stimulated by eating. Insulin secretion is not stimulated between meals, and a decline in the body’s blood glucose levels inhibits the pancreatic islets’ insulin secretion and stimulates the secretion of glucagon, which allows glucose levels to remain in a normal range. Figure 1 demonstrates the relationship between blood glucose levels and the pancreas. With the exception of very few organs, such as the brain and the kidneys, the body’s tissues require insulin for glucose to pass through the cell walls. For patients with diabetes mellitus (DM), either thei Continue reading >>

For Parents & Visitors

For Parents & Visitors

Have you ever tried to fly a remote control airplane or helicopter? If you steer too sharply one way, your plane will crash into the ground. And if you go too far in the opposite direction, the plane will nose directly upward, making it difficult to control. For people with diabetes, controlling blood sugar levels (or blood glucose levels) is kind of like piloting that plane. To stay in the air and have the most fun, you have to keep blood sugar levels steady. Having a blood sugar level that's too high can make you feel lousy, and having it often can be unhealthy. What Is High Blood Sugar? The blood glucose level is the amount of glucose in the blood. Glucose is a sugar that comes from the foods we eat, and it's also formed and stored inside the body. It's the main source of energy for the cells of our body, and it's carried to each cell through the bloodstream. Hyperglycemia (pronounced: hi-per-gly-SEE-me-uh) is the medical word for high blood sugar levels. High blood sugar levels happen when the body either can't make insulin (type 1 diabetes) or can't respond to insulin properly (type 2 diabetes). The body needs insulin so glucose in the blood can enter the cells of the body where it can be used for energy. In people who have developed diabetes, glucose builds up in the blood, resulting in hyperglycemia. Having too much sugar in the blood for long periods of time can cause serious health problems if it's not treated. Hyperglycemia can damage the vessels that supply blood to vital organs, which can increase the risk of heart disease and stroke, kidney disease, vision problems, and nerve problems in people with diabetes. These problems don't usually show up in kids or teens with diabetes who have had the disease for only a few years. However, these health problems can Continue reading >>

Signs And Symptoms Of Canine Diabetes

Signs And Symptoms Of Canine Diabetes

Diabetes in dogs is becoming more of an issue than most people think. Because of the increasing incidence of this, there are a few things that you need to monitor your dog for to know whether or not he might have canine diabetes. These symptoms aren’t specific only to diabetes, but may also signal some other health issues that may need your attention. As always, when in doubt, visit your veterinarian to get a thorough exam. Canine diabetes is a condition in the endocrine system triggered by a deficiency of insulin, or it could also be caused by the body’s inability to respond to this hormone. Studies show that 1 out of every 400 dogs will develop diabetes. This condition could develop as a result of genetics, others have it as an aftermath of other diseases which damaged the pancreas, or it could be a congenital condition. It has also been shown that obesity can be a contributing factor. Although canine diabetes can affect any breed of dog, any age or sex, female dogs are more susceptible and this is especially true when they reach 6 to 9 years old. Some breeds are also more prone to diabetes, particularly Beagles, Samoyeds, and Terriers. There is currently no real cure for diabetes. However, there are some treatments that can be given to manage this disease effectively. Some of them include the administration of insulin injections, oral medication, and managing diet and exercise. Your veterinarian may choose to use any one of or a combination of these treatments. If you happen to notice that your dog has started to drink more water than it normally does, this could be an indicator that they have diabetes. Dogs that drink more water than usual could be showing signs of high blood sugar and they are trying to flush the excess glucose with the water. With excessive wa Continue reading >>

Diabetic Coma Different From Insulin Shock, Role Of Hyperglycemia And Hypoglycemia Crucial

Diabetic Coma Different From Insulin Shock, Role Of Hyperglycemia And Hypoglycemia Crucial

The role of hyperglycemia and hypoglycemia are crucial in diabetic coma. A diabetic coma is a complication of diabetes that leads to unconsciousness. A diabetic coma can result from both hyperglycemia – high blood sugar – or hypoglycemia – low blood sugar. A person in a diabetic coma is still alive, but they do not respond to light, sound, touch or any stimulation. If left untreated a diabetic coma can be fatal. A diabetic coma can be confused with an insulin shock, but although the two may appear similar, they do contain their own unique differences. Diabetic coma vs. insulin shock Insulin shock is the body’s reaction to a drop in blood sugar – or hypoglycemia – as a result of too much insulin. Even though the condition is called insulin shock, there is no shock involved and insulin isn’t the main culprit. Even people without diabetes can experience insulin shock if their blood sugar drops low enough. The condition is called a shock because it makes the body react similarly to when blood pressure drops – a fight or flight response. Symptoms of insulin shock are fast breathing, rapid pulse, dizziness, headache, numbness and hunger. Diabetic coma, on the other hand, causes unconsciousness that can occur over the course of days or even weeks and also cause dehydration. Although both conditions must be treated immediately, diabetic coma can be fatal. Causes of diabetic coma There are various causes of diabetic coma, including diabetic ketoacidosis, diabetic hyperosmolar syndrome, and hypoglycemia. Diabetic ketoacidosis: This is a condition where muscles become starved for energy, so the body begins breaking down fat from storage. This forms a toxin known as ketones and, if untreated, can contribute to diabetic coma. Diabetic hyperosmolar syndrome: Diabetic Continue reading >>

Symptoms And Detection Of Ketoacidosis

Symptoms And Detection Of Ketoacidosis

Symptoms These symptoms are due to the ketone poisoning and should never be ignored. As soon as a person begins to vomit or has difficulty breathing, immediate treatment in an emergency room is required to prevent coma and possible death. Early Signs, Symptoms: Late Signs, Symptoms: very tired and sleepy weakness great thirst frequent urination dry skin and tongue leg cramps fruity odor to the breath* upset stomach* nausea* vomiting* shortness of breath sunken eyeballs very high blood sugars rapid pulse rapid breathing low blood pressure unresponsiveness, coma * these are more specific for ketoacidosis than hyperosmolar syndrome Everyone with diabetes needs to know how to recognize and treat ketoacidosis. Ketones travel from the blood into the urine and can be detected in the urine with ketone test strips available at any pharmacy. Ketone strips should always be kept on hand, but stored in a dry area and replaced as soon as they become outdated. Measurement of Ketones in the urine is very important for diabetics with infections or on insulin pump therapy due to the fact it gives more information than glucose tests alone. Check the urine for ketones whenever a blood sugar reading is 300 mg/dl or higher, if a fruity odor is detected in the breath, if abdominal pain is present, if nausea or vomiting is occurring, or if you are breathing rapidly and short of breath. If a moderate or large amount of ketones are detected on the test strip, ketoacidosis is present and immediate treatment is required. Symptoms for hyperglycemic hyperosmolar syndrome are linked to dehydration rather than acidosis, so a fruity odor to the breath and stomach upset are less likely. How To Detect Ketones During any illness, especially when it is severe and any time the stomach becomes upset, ketone Continue reading >>

Hyperglycemia

Hyperglycemia

University of California San Francisco, Fresno, California Edited By: David A. Wald Temple University School of Medicine Philadelphia, Pennsylvania Objectives The objectives of this module will be to: Review the classic presentation of a patient with hyperglycemia, including DKA and HHS. Review the diagnostic work up of the hyperglycemic patient. Review the principles of managing a patient with hyperglycemia. Hyperglycemia complicating diabetes ranges from the asymptomatic and benign in patients with mild to moderate uncomplicated hyperglycemia to the life-threatening (i.e. diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic state (HHS). DKA and HHS represent a spectrum of complications from diabetes and differ mainly in the level of hyperglycemia, extent of dehydration and presence and degree of ketoacidosis. Each condition revolves around insulin deficiency, either absolute or relative. DKA and HHS are the most serious, acute metabolic complications of diabetes. Generally DKA occurs in younger patients (<65 y/o) with Type 1 diabetes and usually evolves rapidly over 24 hours. HHS usually occurs in older patients (>65 y/o) with poorly controlled Type 2 diabetes and evolves over several days. Both disease entities originate from a reduction in insulin and an increase in counter-regulatory stress hormones. In the emergency department hyperglycemia is most often seen as a complication of diabetes (both types 1 and 2). Hyperglycemia is defined as: Fasting Blood Glucose (for 8 hrs) > 90 – 130 mg/dL Postprandial Blood Glucose > 180 mg/dL Initial Actions and Primary Survey In these patients, a thorough history and physical examination should be performed with a focus on trying to identify a precipitating cause of the hyperglycemia. In patients with an incidental findin Continue reading >>

Hyperosmolar Hyperglycemic State

Hyperosmolar Hyperglycemic State

Acute hyperglycemia, or high blood glucose, may be either the initial presentation of diabetes mellitus or a complication during the course of a known disease. Inadequate insulin replacement (e.g., noncompliance with treatment) or increased insulin demand (e.g., during times of acute illness, surgery, or stress) may lead to acute hyperglycemia. There are two distinct forms: diabetic ketoacidosis (DKA), typically seen in type 1 diabetes, and hyperosmolar hyperglycemic state (HHS), occurring primarily in type 2 diabetes. In type 1 diabetes, no insulin is available to suppress fat breakdown, and the ketones resulting from subsequent ketogenesis manifest as DKA. This is in contrast to type 2 diabetes, in which patients can still secrete small amounts of insulin to suppress DKA, instead resulting in a hyperglycemic state predominated simply by glucose. The clinical presentation of both DKA and HHS is one of polyuria, polydipsia, nausea and vomiting, volume depletion (e.g., dry oral mucosa, decreased skin turgor), and eventually mental status changes and coma. In patients with altered mental status, fingerstick glucose should always be checked in order to exclude serum glucose abnormalities. Several clinical findings pertaining only to DKA include a fruity odor to the breath, hyperventilation, and abdominal pain. HHS patients, in contrast to those with DKA, will present with more extreme volume depletion. The treatment of both DKA and HHS is primarily IV electrolyte and fluid replacement. Insulin for hyperglycemia may be given with caution and under vigilant monitoring of serum glucose. Other treatment options depend on the severity of symptoms and include bicarbonate and potassium replacement. Osmotic diuresis and hypovolemia Hypovolemia resulting from DKA can lead to acute Continue reading >>

> Hyperglycemia And Diabetic Ketoacidosis

> Hyperglycemia And Diabetic Ketoacidosis

When blood glucose levels (also called blood sugar levels) are too high, it's called hyperglycemia. Glucose is a sugar that comes from foods, and is formed and stored inside the body. It's the main source of energy for the body's cells and is carried to each through the bloodstream. But even though we need glucose for energy, too much glucose in the blood can be unhealthy. Hyperglycemia is the hallmark of diabetes — it happens when the body either can't make insulin (type 1 diabetes) or can't respond to insulin properly (type 2 diabetes). The body needs insulin so glucose in the blood can enter the cells to be used for energy. In people who have developed diabetes, glucose builds up in the blood, resulting in hyperglycemia. If it's not treated, hyperglycemia can cause serious health problems. Too much sugar in the bloodstream for long periods of time can damage the vessels that supply blood to vital organs. And, too much sugar in the bloodstream can cause other types of damage to body tissues, which can increase the risk of heart disease and stroke, kidney disease, vision problems, and nerve problems in people with diabetes. These problems don't usually show up in kids or teens with diabetes who have had the disease for only a few years. However, they can happen in adulthood in some people, particularly if they haven't managed or controlled their diabetes properly. Blood sugar levels are considered high when they're above someone's target range. The diabetes health care team will let you know what your child's target blood sugar levels are, which will vary based on factors like your child's age. A major goal in controlling diabetes is to keep blood sugar levels as close to the desired range as possible. It's a three-way balancing act of: diabetes medicines (such as in Continue reading >>

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