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How Do You Reverse Ketoacidosis?

What Are The Causes And Symptoms Of Diabetic Ketoacidosis?

What Are The Causes And Symptoms Of Diabetic Ketoacidosis?

An Overview Diabetic ketoacidosis (DKA) is considered to be one of the most severe metabolic imbalance associated with type 1 diabetes mellitus. Type 1 diabetes mellitus is also known as insulin dependent diabetes mellitus, wherein a patient depends upon external sources of insulin as its body is unable to make it as per the body’s requirement. DKA is seen very commonly in about 35% to 40% of young diabetic patients including small children and teenagers when diagnosed with type 1 diabetes. Patients who are not suffering with type 1 form of diabetes could also fall under the risk of acquiring DKA condition due to various other reasons. Every diabetic patient irrespective of the type of diabetes, can develop DKA, when facing any other form of illness. Diabetic ketoacidosis is often a serious condition that may require immediate hospitalization for the patient. Approximately, 160,000 hospital admissions per year in the United States occur in this regard. Unfortunately DKA is seen to show maximum complication in young adults including teenagers and of course the elderly patients. Complication arising out diabetic ketoacidosis also accounts for a number of deaths in the US for children and young patients suffering from diabetes. The biggest challenge in the management of this condition comes with the lack of awareness of the unmanaged diabetes in patients that is not taken very seriously event today. What is Diabetic Ketoacidosis? Diabetic ketoacidosis is a life threatening complication associated with diabetes. This condition arises when the body produces excess quantities of ketoacids. The risk of developing ketoacidosis is greater in people with Type 1 diabetes. The condition develops when the amount of insulin produced by the body is insufficient. As insulin levels dr Continue reading >>

Treatment Of Insulin-resistant Diabetic Ketoacidosis With Insulin-like Growth Factor I In An Adolescent With Insulin-dependent Diabetes

Treatment Of Insulin-resistant Diabetic Ketoacidosis With Insulin-like Growth Factor I In An Adolescent With Insulin-dependent Diabetes

INSULIN plays a central part in the regulation of carbohydrate, fat, and protein metabolism. Severe insulin resistance, in which treatment with large doses of insulin does not result in adequate metabolic control, is uncommon. Such resistance occurs in the presence of circulating insulin or insulin-receptor antibodies,1 , 2 insulin-receptor abnormalities,3 and episodically in patients with previously typical insulin-dependent diabetes mellitus (IDDM).4 The therapeutic options in patients with severe insulin resistance have been limited, since insulin has been the only available hormone with insulin-like metabolic effects. Recombinant human insulin-like growth factor I (IGF-I), which shares considerable sequence homology as well as biologic properties with insulin,5 has recently become available and has been used in treating patients with Mendenhall's syndrome.6 We describe the use of IGF-I in the treatment of a 16-year-old girl with IDDM complicated by severe episodic insulin resistance. Administration of massive doses of insulin (more than 1000 U per hour) during these episodes failed to achieve glycemic control or reverse ketoacidosis. Treatment with IGF-I rapidly reversed the hyperglycemia and ketoacidosis, and subsequent weekly intravenous infusions of IGF-I markedly improved the degree of insulin sensitivity. The patient was a 16-year-old girl who had had IDDM since the age of 3. She was treated with twice-daily injections of regular and bovine or porcine isophane insulin suspension until the age of seven, at which time she began to receive human insulin. Her glycemic control subsequently improved. At the age of 13, she began to have increasingly frequent (two to three times monthly) episodes of severe hyperglycemia, usually without ketoacidosis. Her serum glucose Continue reading >>

Ketoacidosis Versus Ketosis

Ketoacidosis Versus Ketosis

Some medical professionals confuse ketoacidosis, an extremely abnormal form of ketosis, with the normal benign ketosis associated with ketogenic diets and fasting states in the body. They will then tell you that ketosis is dangerous. Testing Laboratory Microbiology - Air Quality - Mold Asbestos - Environmental - Lead emsl.com Ketosis is NOT Ketoacidosis The difference between the two conditions is a matter of volume and flow rate*: Benign nutritional ketosis is a controlled, insulin regulated process which results in a mild release of fatty acids and ketone body production in response to either a fast from food, or a reduction in carbohydrate intake. Ketoacidosis is driven by a lack of insulin in the body. Without insulin, blood sugar rises to high levels and stored fat streams from fat cells. This excess amount of fat metabolism results in the production of abnormal quantities of ketones. The combination of high blood sugar and high ketone levels can upset the normal acid/base balance in the blood and become dangerous. In order to reach a state of ketoacidosis, insulin levels must be so low that the regulation of blood sugar and fatty acid flow is impaired. *See this reference paper. Here's a table of the actual numbers to show the differences in magnitude: Body Condition Quantity of Ketones Being Produced After a meal: 0.1 mmol/L Overnight Fast: 0.3 mmol/L Ketogenic Diet (Nutritional ketosis): 1-8 mmol/L >20 Days Fasting: 10 mmol/L Uncontrolled Diabetes (Ketoacidosis): >20 mmol/L Here's a more detailed explanation: Fact 1: Every human body maintains the blood and cellular fluids within a very narrow range between being too acidic (low pH) and too basic (high pH). If the blood pH gets out of the normal range, either too low or too high, big problems happen. Fact 2: The Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Diabetic Ketoacidosis (DKA) is an acute, potentially life-threatening complication of diabetes mellitus. For the most part, DKA occurs in people with type 1 diabetes, but it can happen in folks with type 2 diabetes almost as often. DKA is the result of an inadequate amount of insulin. Insulin allows the body to use its major fuel source (glucose) for energy. Since glucose can no longer be burned, it reaches high levels in the bloodstream. This causes increased urine production and dehydration. About 10% of total body fluids are lost as the patient slips into diabetic ketoacidosis. When there is not enough insulin, the body burns fat instead. Fat breaks down into acids which in turn produce toxic acidic substances known as ketones. These build in the bloodstream causing a dangerous situation. Loss of potassium and other salts which the body needs in the excessive urination is also common. DKA is therefore a medical emergency which if untreated can result in coma and possibly death. In the early stages, it may be possible to treat DKA at home, but if it is more advanced, management should take place in a properly equipped setting such as a hospital. The keys to prevention of DKA include awareness of its warning signs along with frequent blood glucose monitoring and checking urine or blood ketone levels as needed. Causative factors The most common events that cause a person with diabetes to develop diabetic ketoacidosis are: Infection such as diarrhea, vomiting, and/or high fever (40%), Missed, inadequate, or “bad” insulin (25%), New diagnosis or previously unknown diabetes (15%). Various other causes: pregnancy, heart attack, stroke, trauma, stress, alcohol abuse, drug abuse, and surgery. Approximately 5% to 10% of cases have no identifiable cause. Signs and Symptoms Continue reading >>

Understanding And Treating Diabetic Ketoacidosis

Understanding And Treating Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a serious metabolic disorder that can occur in animals with diabetes mellitus (DM).1,2 Veterinary technicians play an integral role in managing and treating patients with this life-threatening condition. In addition to recognizing the clinical signs of this disorder and evaluating the patient's response to therapy, technicians should understand how this disorder occurs. DM is caused by a relative or absolute lack of insulin production by the pancreatic b-cells or by inactivity or loss of insulin receptors, which are usually found on membranes of skeletal muscle, fat, and liver cells.1,3 In dogs and cats, DM is classified as either insulin-dependent (the body is unable to produce sufficient insulin) or non-insulin-dependent (the body produces insulin, but the tissues in the body are resistant to the insulin).4 Most dogs and cats that develop DKA have an insulin deficiency. Insulin has many functions, including the enhancement of glucose uptake by the cells for energy.1 Without insulin, the cells cannot access glucose, thereby causing them to undergo starvation.2 The unused glucose remains in the circulation, resulting in hyperglycemia. To provide cells with an alternative energy source, the body breaks down adipocytes, releasing free fatty acids (FFAs) into the bloodstream. The liver subsequently converts FFAs to triglycerides and ketone bodies. These ketone bodies (i.e., acetone, acetoacetic acid, b-hydroxybutyric acid) can be used as energy by the tissues when there is a lack of glucose or nutritional intake.1,2 The breakdown of fat, combined with the body's inability to use glucose, causes many pets with diabetes to present with weight loss, despite having a ravenous appetite. If diabetes is undiagnosed or uncontrolled, a series of metab Continue reading >>

Diabetes Complications In Dogs And Cats: Diabetes Ketoacidosis (dka)

Diabetes Complications In Dogs And Cats: Diabetes Ketoacidosis (dka)

Unfortunately, we veterinarians are seeing an increased prevalence of diabetes mellitus in dogs and cats. This is likely due to the growing prevalence of obesity (secondary to inactive lifestyle, a high carbohydrate diet, lack of exercise, etc.). So, if you just had a dog or cat diagnosed with diabetes mellitus, what do you do? First, we encourage you to take a look at these articles for an explanation of the disease: Diabetes Mellitus (Sugar Diabetes) in Dogs Once you have a basic understanding of diabetes mellitus (or if you already had one), this article will teach you about life-threatening complications that can occur as a result of the disease; specifically, I discuss a life-threatening condition called diabetes ketoacidosis (DKA) so that you know how to help prevent it! What is DKA? When diabetes goes undiagnosed, or when it is difficult to control or regulate, the complication of DKA can occur. DKA develops because the body is so lacking in insulin that the sugar can’t get into the cells -- resulting in cell starvation. Cell starvation causes the body to start breaking down fat in an attempt to provide energy (or a fuel source) to the body. Unfortunately, these fat breakdown products, called “ketones,” are also poisonous to the body. Symptoms of DKA Clinical signs of DKA include the following: Weakness Not moving (in cats, hanging out by the water bowl) Not eating to complete anorexia Large urinary clumps in the litter box (my guideline? If it’s bigger than a tennis ball, it’s abnormal) Weight loss (most commonly over the back), despite an overweight body condition Excessively dry or oily skin coat Abnormal breath (typically a sweet “ketotic” odor) In severe cases DKA can also result in more significant signs: Abnormal breathing pattern Jaundice Ab Continue reading >>

Alcoholic Ketoacidosis Treatment & Management

Alcoholic Ketoacidosis Treatment & Management

Approach Considerations Treatment of alcoholic ketoacidosis (AKA) is directed toward reversing the 3 major pathophysiologic causes of the syndrome, which are: This goal can usually be achieved through the administration of dextrose and saline solutions. [4] Carbohydrate and fluid replacement reverse the pathophysiologic derangements that lead to AKA by increasing serum insulin levels and suppressing the release of glucagon and other counterregulatory hormones. Dextrose stimulates the oxidation of NADH and aids in normalizing the NADH/NAD+ ratio. Fluids alone do not correct AKA as quickly as do fluids and carbohydrates together. Indeed, evidence-based guidelines by Flannery et al, on the management of intensive care unit patients with a chronic alcohol disorder, including symptoms that mimic or mask Wernicke encephalopathy, recommend that in cases of suspected AKA, dextrose-containing fluids be used in place of normal saline during the first day of admission. [23] In alcoholics, thiamine (100 mg IV or IM) should be administered prior to any glucose-containing solutions. This will decrease the risk of precipitating Wernicke encephalopathy or Korsakoff syndrome. [13] Phosphate depletion is also common in alcoholics. The plasma phosphate concentration may be normal on admission; however, it typically falls to low levels with therapy as insulin drives phosphate into the cells. When present, severe hypophosphatemia may be associated with marked and possibly life-threatening complications, such as myocardial dysfunction, in these patients. Institute appropriate treatment for serious, coexisting, acute illnesses. These may include pancreatitis, hepatitis, heart failure, or infection. Prevention of AKA involves the treatment of chronic alcohol abuse. Transfer considerations Pati Continue reading >>

How To Help Someone In A Coma

How To Help Someone In A Coma

Author's Sidebar: Every once in a while, I'll get a phone call or an email message from a person, who has a relative in the hospital in a diabetic coma. I can usually tell by the tone in their voice that they are desperate, afraid and uncertain what to do. These types of phone calls are difficult, because there's nothing that I can do to help them. Usually, I suggest that the person make sure that they share as much information that they can about the person's health with the doctors and nurses. The more that you know about the person's health, the better it can help the doctors understand what is happening. Another thing that I usually suggest is to keep a notebook or journal of what's going on and ask questions, but be respectful to the medical staff. Use the notebook for taking notes when the doctors tell you things about the patient's condition, etc. Otherwise, you will never remember what was said to relay to other family members. When a large family is involved it gets tiring to keep repeating the same information -- so they can read your notebook. Also, write down all the pertinent phone numbers and emails of people who would need to be contacted when changes in condition occur. There are usually a lot of people who want this information and having email addresses makes it easier than trying to call everyone. Keeping notes is also a good way to keep busy. A journal may not only serve as a method for coping with grief, it may also be helpful for the patient when they come out of the coma -- to realize what happened to them. If the person has a smartphone or similar device, usually I'll suggest that they google phrases like "diabetic coma" to better understand what is going on. If the hospital allows it, bring a small CD player or tape player and play some of the p Continue reading >>

Feline Diabetic Ketoacidosis

Feline Diabetic Ketoacidosis

Fall 2008 Ketoacidosis is a metabolic imbalance that is most commonly seen as a sequel to unmanaged or poorly regulated diabetes mellitus. It is caused by the breakdown of fat and protein in a compensatory effort for the need of more metabolic energy. The excessive breakdown of these stored reserves creates a toxic by-product in the form of ketones. As ketones build up in the blood stream, pH and electrolyte imbalances proceed. This condition is a potentially life-threatening emergency that requires immediate medical attention. Diabetes mellitus is a common endocrine disease in geriatric felines. It is caused by a dysfunction in the beta cells of the exocrine pancreas resulting in an absolute or relative deficiency of insulin. Insulin has been called the cells' gatekeeper. It attaches to the surface of cells and permits glucose, the cells' primary energy source, to enter from the blood. A lack of insulin results in a build up of glucose in the blood, physiologically causing a state of cellular starvation. In response to this condition the body begins to increase the mobilization of protein and fat storage. Fatty acids are released from adipose tissue, which are then oxidized by the liver. Normally, these fatty acids are formed into triglycerides. However, without insulin, these fatty acids are converted into ketone bodies, which cannot be utilized by the body. Together with the increased production and decreased utilization an abnormally high concentration of ketone bodies develop. These fixed acids are buffered by bicarbonate; however, the excessive amounts overwhelm and deplete the bicarbonate leading to an increase in arterial hydrogen ion concentration and a decrease in serum bicarbonate. This increase in hydrogen ions lowers the body's pH, leading to a metabolic ac Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

A Preventable Crisis People who have had diabetic ketoacidosis, or DKA, will tell you it’s worse than any flu they’ve ever had, describing an overwhelming feeling of lethargy, unquenchable thirst, and unrelenting vomiting. “It’s sort of like having molasses for blood,” says George. “Everything moves so slow, the mouth can feel so dry, and there is a cloud over your head. Just before diagnosis, when I was in high school, I would get out of a class and go to the bathroom to pee for about 10–12 minutes. Then I would head to the water fountain and begin drinking water for minutes at a time, usually until well after the next class had begun.” George, generally an upbeat person, said that while he has experienced varying degrees of DKA in his 40 years or so of having diabetes, “…at its worst, there is one reprieve from its ill feeling: Unfortunately, that is a coma.” But DKA can be more than a feeling of extreme discomfort, and it can result in more than a coma. “It has the potential to kill,” says Richard Hellman, MD, past president of the American Association of Clinical Endocrinologists. “DKA is a medical emergency. It’s the biggest medical emergency related to diabetes. It’s also the most likely time for a child with diabetes to die.” DKA occurs when there is not enough insulin in the body, resulting in high blood glucose; the person is dehydrated; and too many ketones are present in the bloodstream, making it acidic. The initial insulin deficit is most often caused by the onset of diabetes, by an illness or infection, or by not taking insulin when it is needed. Ketones are your brain’s “second-best fuel,” Hellman says, with glucose being number one. If you don’t have enough glucose in your cells to supply energy to your brain, yo Continue reading >>

What Is Diabetic Ketoacidosis?

What Is Diabetic Ketoacidosis?

Diabetic ketoacidosis is a serious condition characterized by high blood sugar (hyperglycemia), low insulin, and the presence of moderate to large amounts of ketones in the blood. It's a medical emergency that requires treatment in a hospital. If not treated in a timely fashion, ketoacidosis can lead to coma and death. While diabetic ketoacidosis (or DKA) is much more common among people with type 1 diabetes, it can also occur in people with type 2 diabetes, so ketone monitoring is something everyone with diabetes should understand. Diabetic Ketoacidosis Symptoms Signs and symptoms of ketoacidosis include: Thirst or a very dry mouth Frequent urination Fatigue and weakness Nausea Vomiting Dry or flushed skin Abdominal pain Deep breathing A fruity breath odor What Are Ketones? Ketones, or ketone bodies, are acidic byproducts of fat metabolism. It's normal for everyone to have a small amount of ketones in the bloodstream, and after a fast of 12 to16 hours, there may be detectable amounts in the urine. As is the case with glucose, if blood levels of ketones get too high, they spill over into the urine. An elevated level of ketones in the blood is known as ketosis. People who follow low-carbohydrate diets often speak of ketosis as a desirable state — it's evidence that their bodies are burning fat, not carbohydrate. But the level of ketosis that results from low carbohydrate consumption isn't harmful and is much lower than the level seen in diabetic ketoacidosis. When Should Ketones Be Monitored? Ketone monitoring is less of a concern for people with type 2 diabetes than for those with type 1 diabetes. This is because most people with type 2 diabetes still make some of their own insulin, making diabetic ketoacidosis less likely to develop. Nonetheless, people with type 2 d Continue reading >>

What You Should Know About Recovery From Diabetic Coma

What You Should Know About Recovery From Diabetic Coma

A diabetic coma occurs when a person with diabetes loses consciousness. It can occur in people with type 1 or type 2 diabetes. A diabetic coma occurs when blood sugar levels become either too low or too high. The cells in your body require glucose to function. High blood sugar, or hyperglycemia, can make you feel lightheaded and lose consciousness. Low blood sugar, or hypoglycemia, can cause dehydration to the point where you may lose consciousness. Usually, you can prevent hyperglycemia or hypoglycemia from progressing to a diabetic coma. If a diabetic coma occurs, it’s likely that your doctor can balance your blood glucose levels and restore your consciousness and health quickly if they can respond to your condition in a timely manner. You can also slip into a diabetic coma if you develop diabetic ketoacidosis. Diabetic ketoacidosis (DKA) is a buildup of chemicals called ketones in your blood. Hypoglycemia The symptoms of hypoglycemia may include: headache fatigue dizziness confusion heart palpitations shakiness Hyperglycemia If you have hyperglycemia, you may experience noticeably increased thirst and you may urinate more frequently. A blood test would also reveal higher levels of glucose in your blood stream. A urine test can also show that your glucose levels are too high. DKA causes high levels of blood glucose. The symptoms also include increased thirst and a frequent need to urinate. Other symptoms of elevated ketone levels include: feeling tired having an upset stomach having flushed or dry skin If you have more severe diabetic coma symptoms, call 911. Severe symptoms may include: vomiting difficulty breathing confusion weakness dizziness A diabetic coma is a medical emergency. It can lead to brain damage or death if you don’t get treatment. Treating hyperg Continue reading >>

What You Should Know About Diabetic Ketoacidosis

What You Should Know About Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a buildup of acids in your blood. It can happen when your blood sugar is too high for too long. It could be life-threatening, but it usually takes many hours to become that serious. You can treat it and prevent it, too. It usually happens because your body doesn't have enough insulin. Your cells can't use the sugar in your blood for energy, so they use fat for fuel instead. Burning fat makes acids called ketones and, if the process goes on for a while, they could build up in your blood. That excess can change the chemical balance of your blood and throw off your entire system. People with type 1 diabetes are at risk for ketoacidosis, since their bodies don't make any insulin. Your ketones can also go up when you miss a meal, you're sick or stressed, or you have an insulin reaction. DKA can happen to people with type 2 diabetes, but it's rare. If you have type 2, especially when you're older, you're more likely to have a condition with some similar symptoms called HHNS (hyperosmolar hyperglycemic nonketotic syndrome). It can lead to severe dehydration. Test your ketones when your blood sugar is over 240 mg/dL or you have symptoms of high blood sugar, such as dry mouth, feeling really thirsty, or peeing a lot. You can check your levels with a urine test strip. Some glucose meters measure ketones, too. Try to bring your blood sugar down, and check your ketones again in 30 minutes. Call your doctor or go to the emergency room right away if that doesn't work, if you have any of the symptoms below and your ketones aren't normal, or if you have more than one symptom. You've been throwing up for more than 2 hours. You feel queasy or your belly hurts. Your breath smells fruity. You're tired, confused, or woozy. You're having a hard time breathing. Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Print Overview Diabetic ketoacidosis is a serious complication of diabetes that occurs when your body produces high levels of blood acids called ketones. The condition develops when your body can't produce enough insulin. Insulin normally plays a key role in helping sugar (glucose) — a major source of energy for your muscles and other tissues — enter your cells. Without enough insulin, your body begins to break down fat as fuel. This process produces a buildup of acids in the bloodstream called ketones, eventually leading to diabetic ketoacidosis if untreated. If you have diabetes or you're at risk of diabetes, learn the warning signs of diabetic ketoacidosis — and know when to seek emergency care. Symptoms Diabetic ketoacidosis signs and symptoms often develop quickly, sometimes within 24 hours. For some, these signs and symptoms may be the first indication of having diabetes. You may notice: Excessive thirst Frequent urination Nausea and vomiting Abdominal pain Weakness or fatigue Shortness of breath Fruity-scented breath Confusion More-specific signs of diabetic ketoacidosis — which can be detected through home blood and urine testing kits — include: High blood sugar level (hyperglycemia) High ketone levels in your urine When to see a doctor If you feel ill or stressed or you've had a recent illness or injury, check your blood sugar level often. You might also try an over-the-counter urine ketones testing kit. Contact your doctor immediately if: You're vomiting and unable to tolerate food or liquid Your blood sugar level is higher than your target range and doesn't respond to home treatment Your urine ketone level is moderate or high Seek emergency care if: Your blood sugar level is consistently higher than 300 milligrams per deciliter (mg/dL), or 16.7 mill Continue reading >>

Diabetic Ketoacidosis In Children

Diabetic Ketoacidosis In Children

Pathophysiology Management of diabetic ketoacidosis Fluid and electrolyte therapy Investigating the cause of ketoacidosis Morbidity and mortality from diabetic ketoacidosis in children Continue reading >>

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