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How Does Ketoacidosis Affect The Kidneys

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes mellitus.[1] Signs and symptoms may include vomiting, abdominal pain, deep gasping breathing, increased urination, weakness, confusion, and occasionally loss of consciousness.[1] A person's breath may develop a specific smell.[1] Onset of symptoms is usually rapid.[1] In some cases people may not realize they previously had diabetes.[1] DKA happens most often in those with type 1 diabetes, but can also occur in those with other types of diabetes under certain circumstances.[1] Triggers may include infection, not taking insulin correctly, stroke, and certain medications such as steroids.[1] DKA results from a shortage of insulin; in response the body switches to burning fatty acids which produces acidic ketone bodies.[3] DKA is typically diagnosed when testing finds high blood sugar, low blood pH, and ketoacids in either the blood or urine.[1] The primary treatment of DKA is with intravenous fluids and insulin.[1] Depending on the severity, insulin may be given intravenously or by injection under the skin.[3] Usually potassium is also needed to prevent the development of low blood potassium.[1] Throughout treatment blood sugar and potassium levels should be regularly checked.[1] Antibiotics may be required in those with an underlying infection.[6] In those with severely low blood pH, sodium bicarbonate may be given; however, its use is of unclear benefit and typically not recommended.[1][6] Rates of DKA vary around the world.[5] In the United Kingdom, about 4% of people with type 1 diabetes develop DKA each year, while in Malaysia the condition affects about 25% a year.[1][5] DKA was first described in 1886 and, until the introduction of insulin therapy in the 1920s, it was almost univ Continue reading >>

Severe Acute Renal Failure In A Patient With Diabetic Ketoacidosis.

Severe Acute Renal Failure In A Patient With Diabetic Ketoacidosis.

Abstract Acute renal failure (ARF) is a rare but potentially fatal complication of diabetic ketoacidosis (DKA). Early recognition and aggressive treatment of ARF during DKA may im-prove the prognosis of these patients. We present a case report of a 12 year old female admitted to the hospital with severe DKA as the 1s t manifestation of her diabetes mellitus. She presented with severe metabolic acidosis, hypophosphatemia, and oliguric ARF. In addition, rhabdomyolysis was noted during the course of DKA which probably contributed to the ARF. Management of DKA and renal replacement therapy resulted in quick recovery of renal function. We suggest that early initiation of renal replacement therapy for patients with DKA developing ARF may improve the potentially poor outcome of patients with ARF associated with DKA. Continue reading >>

Ketosis & Kidney Failure

Ketosis & Kidney Failure

Ketosis happens when your body resorts to fat for energy after your stored carbohydrates have been burned out. It often occurs when people fast and exercise. But most commonly, ketosis occurs in people who eat low-carb, high-protein diets, which are also called ketogenic diets. There’s some evidence that ketosis can tax your kidneys, leading to kidney stones and low blood pressure. In diabetics, a variant of ketosis can be fatal. However, a small but growing group of health professionals say ketosis is not the poison you’ve been lead to think it was, and it may be better for you than high-carbohydrate eating. Your specific dietary habits are best advised by your healthcare provider or nutritionist. Video of the Day Ketosis happens when you get a buildup of a substance known as ketones, or ketone bodies in your blood. They are released when your body’s carbohydrate stores run out and you have to break down fat stores for energy. Dieters tend to deliberately cause ketosis because it makes you feel less hungry. However, ketosis also makes you feel tired and sluggish, because as "Medical News Today" reports, ketones aren’t the most efficient source of energy, especially for your brain. Ketosis can also harm your kidneys. Annually, more than 100,000 people are diagnosed with kidney failure in the United States, reports the National Institute of Diabetes and Digestive and Kidney Diseases, or NIDDK. The condition is marked by the inability of your kidneys to do their job of eliminating wastes. One treatment for kidney failure is dialysis, a draining and lengthy artificial blood cleansing process. Another option is a kidney transplant. The NIDDK states that the cost of care for patients with kidney failure reached close to $32 billion in 2005. The federal government sub Continue reading >>

Diabetes Complications

Diabetes Complications

Complications caused by diabetes People with diabetes must routinely monitor and regulate their blood sugar. No matter how careful you may be, there’s still a possibility that a problem might arise. There are two types of complications you may experience: acute and chronic. Acute complications require emergency care. Examples include hypoglycemia and ketoacidosis. If left untreated, these conditions can cause: seizures loss of consciousness death Chronic complications occur when diabetes isn’t managed properly. Diabetes causes high blood sugar levels. If not controlled well over time, high blood sugar levels can damage various organs, including the: eyes kidneys heart skin Unmanaged diabetes can also cause nerve damage. People with diabetes can experience sudden drops in their blood sugar. Skipping a meal or taking too much insulin or other medications that increase insulin levels in the body are common causes. People who are on other diabetes medications that do not increase insulin levels are not at risk for hypoglycemia. Symptoms can include: blurry vision rapid heartbeat headache shaking dizziness If your blood sugar gets too low, you can experience fainting, seizures, or coma. This is a complication of diabetes that occurs when your body cannot use sugar, or glucose, as a fuel source because your body has no insulin or not enough insulin. If your cells are starved for energy, your body begins to break down fat. Potentially toxic acids called ketone bodies, which are byproducts of fat breakdown, build up in the body. This can lead to: dehydration abdominal pain breathing problems Diabetes can damage blood vessels in the eyes and cause various problems. Possible eye conditions may include: Cataracts Cataracts are two to five times more likely to develop in people Continue reading >>

Incidence And Characteristics Of Acute Kidney Injury In Severe Diabetic Ketoacidosis

Incidence And Characteristics Of Acute Kidney Injury In Severe Diabetic Ketoacidosis

Abstract Acute kidney injury is a classical complication of diabetic ketoacidosis. However, to the best of our knowledge, no study has reported the incidence and characteristics of acute kidney injury since the consensus definition was issued. Retrospective study of all cases of severe diabetic ketoacidosis hospitalised consecutively in a medical surgical tertiary ICU during 10 years. Patients were dichotomised in with AKI and without AKI on admission according to the RIFLE classification. Clinical and biological parameters were compared in these populations. Risk factors of presenting AKI on admission were searched for. Results Ninety-four patients were included in the study. According to the RIFLE criteria, 47 patients (50%) presented acute kidney injury on admission; most of them were in the risk class (51%). At 12 and 24 hours, the percentage of AKI patients decreased to 26% and 27% respectively. During the first 24 hours, 3 patients needed renal replacement therapy. Acute renal failure on admission was associated with a more advanced age, SAPS 2 and more severe biological impairments. Treatments were not different between groups except for insulin infusion. Logistic regression found 3 risk factors of presenting AKI on admission: age (odds ratio 1.060 [1.020–1.100], p<0.01), blood glucose (odds ratio 1.101 [1.039–1.166], p<0.01) and serum protein (odds ratio 0.928 [0.865–0.997], p = 0.04). Acute kidney injury is frequently associated with severe diabetic ketoacidosis on admission in ICU. Most of the time, this AKI is transient and characterised by a volume-responsiveness to fluid infusion used in DKA treatment. Age, blood glucose and serum protein are associated to the occurrence of AKI on ICU admission. Figures Citation: Orban J-C, Maizière E-M, Ghaddab A, V Continue reading >>

Diabetic Ketoacidosis Associated With Acute Kidney Injury

Diabetic Ketoacidosis Associated With Acute Kidney Injury

A new Journal of American Medical Association article has shown that there is a high rate of occurrence of acute kidney injury (AKI) in children hospitalized with a diagnosis diabetic ketoacidosis (DKA). Acute kidney injury is one of the most common causes of renal injury that can arise from several aetiologies. Based on predisposing factors, the causes may be categorized into 3 classes: pre-renal, renal or post-renal. In cases of volume depletion, like that which occurs in diabetic ketoacidosis (a complication of diabetes where there is high ketone production), perfusion to kidneys is impaired and that is when the kidneys start to lose their functioning. Since acute kidney injury in children is associated with a poor short term and long term outcome, in a new JAMA article, and for the first time, researchers have evaluated the rate of acute kidney injury (AKI) in pediatric patients who were hospitalized for the diabetic ketoacidosis. This study was conducted at the British Columbia Children’s Hospital from 2008 through 2013. 165 children aged 18 years or younger with type 1 diabetes, DKA and with complete medical records available for data analysis were included. The primary outcome was the development of acute kidney injury defined using Kidney Disease/Improving Global Outcomes serum creatinine criteria. As per findings, in the designed timeframe, of the 165 children hospitalized for DKA, 106 (64.2%) developed AKI.Two children required hemodialysis. Statistical analysis has shown that a serum bicarbonate level of less than 10 mEq/L was associated with a 5-fold increased risk of developing severe kidney injury. This means that the incidence of acute kidney injury is directly associated with the severity of the acidosis resulting from DKA. Increase in heart rate (demo Continue reading >>

Diabetic Ketoacidosis In Chronic Kidney Disease Masquerading As Acute Pancreatitis

Diabetic Ketoacidosis In Chronic Kidney Disease Masquerading As Acute Pancreatitis

Robin George Manappallil Department of Medicine, Mar Baselios Medical Mission Hospital, Kothamangalam, Ernakulam, Kerala, India. Abstract Diabetic ketoacidosis (DKA) is a life threatening acute complication of type 1 diabetes. Since diabetic patients may have hypertriglyceridemia, they are at risk of developing acute pancreatitis (AP). Hyperamylasemia may suggest a diagnosis of AP, but levels may be elevated in DKA. Hence, serum lipase levels correlate better with the diagnosis of AP. However, pancreatic enzymes are excreted by the kidneys and their levels are elevated in patients with chronic kidney disease (CKD). This report describes a patient with type 1 diabetes and CKD stage 4, not on hemodialysis, who presented with DKA and had very high levels of pancreatic enzymes in the absence of pancreatitis. Keywords : Diabetes Ketoacidosis, Kidney, Renal Insufficiency, Pancreatitis, Hypertriglyceridemia. Introduction Acute pancreatitis (AP) is an acute inflammatory disorder of the pancreas. In 10-15% cases, the condition is life threatening. Epigastric pain is the predominant symptom, which may radiate to the back, chest, flanks or lower abdomen. Serum amylase and lipase levels are elevated in AP. Abdominal contrast enhanced computed tomography (CT), abdominal ultrasound, magnetic resonance imaging (MRI) are radiological methods which aid in diagnosis of AP [1]. However, elevated pancreatic enzyme levels have been noted in CKD patients [2,3]. Features like epigastric pain and elevated pancreatic enzymes are also seen in DKA [4]. Moreover, AP can present or coexist with DKA [5,6]. This case report aims to highlight the importance of elevated pancreatic enzymes in DKA and CKD, and the diagnostic dilemma posed by such elevations in patients with these two illnesses. Case Repo Continue reading >>

I’ll See Your Ketoacidosis And Raise You A Renal Failure

I’ll See Your Ketoacidosis And Raise You A Renal Failure

A while back I posted on a paper that appeared in The Lancet about an obese woman who came to the emergency room with gastroenteritis and was misdiagnosed as being in diabetic ketoacidosis (a life-threatening disorder). She was misdiagnosed because the pinheads covering the ER couldn’t get past the fact that she had been on a low-carb diet. At the time I posted on this travesty I noted that this Lancet paper would from here on out be waved in the face of anyone who was following or advocated a low-carb diet as proof that such a diet is dangerous and can cause diabetic ketoacidosis (DKA). Well, now we’ve got an answer. Next time someone tells you that it has been proven that low-carb diets are dangerous and can cause ketoacidosis, you can resort to poker terminology and reply that you’ll see their ketoacidosis and raise them a renal failure. A few days ago I got wind of a paper published a few years ago that can be used as a counterpoint to the above mentioned idiotic paper in The Lancet that has given low-carbers such a bad time. This paper, published in the journal Renal Failure in 1998, is, like the other paper, a case report. The short version is as follows: An obese young man arrived comatose in the emergency room. In an effort to lose weight he had been consuming a high-carbohydrate canned beverage as his sole source of nutrition for the two weeks prior. His blood sugar–at about 20 times normal–was extremely elevated and led to a diagnosis of diabetic ketoacidosis. The physicians on staff treated the patient appropriately, and he, over the next 20 hours or so, regained consciousness as his blood sugar levels and other lab parameters began to normalize. During a lab analysis 22 hours after admission the doctors found the patient to be breaking down and rel Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Professor of Pediatric Endocrinology University of Khartoum, Sudan Introduction DKA is a serious acute complications of Diabetes Mellitus. It carries significant risk of death and/or morbidity especially with delayed treatment. The prognosis of DKA is worse in the extremes of age, with a mortality rates of 5-10%. With the new advances of therapy, DKA mortality decreases to > 2%. Before discovery and use of Insulin (1922) the mortality was 100%. Epidemiology DKA is reported in 2-5% of known type 1 diabetic patients in industrialized countries, while it occurs in 35-40% of such patients in Africa. DKA at the time of first diagnosis of diabetes mellitus is reported in only 2-3% in western Europe, but is seen in 95% of diabetic children in Sudan. Similar results were reported from other African countries . Consequences The latter observation is annoying because it implies the following: The late diagnosis of type 1 diabetes in many developing countries particularly in Africa. The late presentation of DKA, which is associated with risk of morbidity & mortality Death of young children with DKA undiagnosed or wrongly diagnosed as malaria or meningitis. Pathophysiology Secondary to insulin deficiency, and the action of counter-regulatory hormones, blood glucose increases leading to hyperglycemia and glucosuria. Glucosuria causes an osmotic diuresis, leading to water & Na loss. In the absence of insulin activity the body fails to utilize glucose as fuel and uses fats instead. This leads to ketosis. Pathophysiology/2 The excess of ketone bodies will cause metabolic acidosis, the later is also aggravated by Lactic acidosis caused by dehydration & poor tissue perfusion. Vomiting due to an ileus, plus increased insensible water losses due to tachypnea will worsen the state of dehydr Continue reading >>

Editorial Review Diabetic Ketoacidosis: Role Of The Kidney In The Acid-base Homeostasis Re-evaluated

Editorial Review Diabetic Ketoacidosis: Role Of The Kidney In The Acid-base Homeostasis Re-evaluated

The development of diabetic ketoacidosis (DKA) involves a series of closely interrelated derangements of intermediary metabolism and of body fluid volume and composition whose fundamental nature has not been completely unraveled [1–8]. The composite clinical picture in full-blown DKA on admission includes hyperglycemia with hyperosmolality, metabolic acidosis due to the accumulation of ketoacids, extracellular and intracellular fluid (ECF and ICF, respectively) volume depletion, and varying degrees of electrolyte deficiency, particularly of potassium and phosphate [9–11]. Since proper correction of the alterations in volume status, acid-base, and electrolyte composition is critical for survival, a clear understanding of the pathogenesis of these derangements is essential for the adequate management of DKA. The present review will focus on the role of the kidney in the pathogenesis of the different patterns of electrolyte and acid-base composition observed on admission for and during recovery from DKA. Special emphasis will be placed on the role of the kidney in the defense of acid-base homeostasis during the recovery phase. Other aspects of the alterations that develop in DKA have been reviewed in detail elsewhere [12–14]. Continue reading >>

Diabetic Nephropathy - Kidney Disease

Diabetic Nephropathy - Kidney Disease

Tweet Kidney disease amongst diabetics is commonly called diabetic nephropathy. Statistically, around 40% of people with diabetes develop nephropathy but it is possible to prevent or delay through control of both blood glucose and blood pressure levels. Diabetes affects the arteries of the body and as the kidneys filter blood from many arteries, kidney problems are a particular risk for people with diabetes. What is diabetic nephropathy? Nephropathy is a general term for the deterioration of proper functioning in the kidneys. At an advanced level, this is called end-stage renal disease or ESRD. ESRD often stems from diabetes, with diabetes causing just under half of all cases. Diabetic nephropathy can affect people with both type 1 and type 2 diabetes. Diabetic nephropathy is divided into five stages of deterioration, with the final one being ESRD. It commonly takes over 20 years for patients to reach stage 5. Symptoms of kidney disease The symptoms of diabetic nephropathy tend to become apparent once the condition has reached the later stages. Typically the following symptoms may start to be noticed around stage four of its progression: Swelling of the ankles, feet, lower legs or hands caused by retention of water Darker urine, caused by blood in the urine Becoming short of breath, when climbing the stairs for instance Tiredness as a result of a lack of oxygen in the blood Nausea or vomiting To help catch nephropathy before the later stages develop, people with diabetes should be screened for kidney complications once a year. The screening test involves a simple urine sample which is tested to detect whether protein is present in the urine. Read more on kidney disease screening What are the causes of diabetic nephropathy? Statistics show that development of kidney dise Continue reading >>

The Link Between Diabetes & Kidney Disease

The Link Between Diabetes & Kidney Disease

How can diabetes affect the kidneys? People with diabetes need to watch their glucose levels and blood pressure, as over time high blood glucose levels and blood pressure can damage the tiny blood vessels in the filters of the kidneys. At this early stage, this damage causes small amounts of protein to be passed in the urine which is known as microalbumin. In a later stage, so much protein can be lost from the blood that water moves into the body tissues and causes swelling. After a number of years, the kidney filters can fail completely. Wouldn't I know if I had kidney damage? Not necessarily - there is actually a high chance you wouldn't know at all. There are no warning signs for chronic kidney disease and you could lose up to 90 per cent of your kidney function before you felt unwell. How can I find out if my kidneys are affected? Chronic kidney disease is common in people who have diabetes. The only way to know if you are affected is to have a yearly kidney health check by your doctor or diabetes specialist. The doctor or specialist will order a blood and urine test and will also check your blood pressure to determine if you have any signs of kidney damage. Although there is no cure for chronic kidney disease, early detection and treatment is extremely important to slow or halt the progression of the disease. If chronic kidney disease is not detected and treated early, kidney function may continue to worsen, progressing to end stage kidney disease. In order to survive, people with end stage kidney disease may need to have dialysis or a kidney transplant. Kidney disease can also worsen other serious diabetes complications such as eye disease, nerve damage and cardiovascular disease. For further information about your risk of developing chronic kidney disease talk to Continue reading >>

Diabetes And Kidney Failure (stage 5)

Diabetes And Kidney Failure (stage 5)

What is diabetes? Diabetes happens when your body does not make enough insulin or cannot use insulin properly. Insulin is a hormone. It controls how much sugar is in your blood. A high level of sugar in your blood can cause damage to the very small blood vessels in your kidneys. Over time, this can lead to kidney disease and kidney failure. What is kidney failure? Healthy kidneys do many important jobs. They filter your blood, keep fluids in balance, and make hormones that help your body control blood pressure, have healthy bones, and make red blood cells. If you have kidney failure, it means your kidneys have stopped working well enough to do these important jobs and keep you alive. As a result: Harmful wastes build up in your body Your blood pressure may rise Your body may hold too much fluid Your body cannot make enough red blood cells When this happens, you need treatment to replace the work of your failed kidneys. There is no cure for kidney failure. A person with kidney failure needs treatment to live. Three types of treatment can be used if your kidneys have failed: Hemodialysis Peritoneal dialysis Kidney transplantation Your healthcare team will discuss these different treatments with you and answer all your questions. They will help you choose the best treatment for you, based on your general health, lifestyle, and treatment preference. Your decision does not need to be final. Many people have used each one of these treatments at different times in their lifetime. If I have kidney failure and diabetes, what will my treatment involve? A kidney doctor (called a nephrologist) will plan your treatment with you, your family, and your dietitian. In addition to dialysis or a transplant, you will need to: Keep your blood sugar under control. This is usually done with d Continue reading >>

Ketones

Ketones

By-products formed when the body breaks down fat for energy. When the body is starved of glucose or, as in the case of Type 1 diabetes, does not have enough insulin to use the glucose that is in the bloodstream, it begins breaking down fat reserves for energy. Unlike glucose, which “burns clean,” the breakdown of fat creates potentially toxic by-products called ketones, which accumulate in the blood. An excessive amount of ketones in the blood is called ketosis. When the kidneys filter ketones into the urine, the condition is called ketonuria and can be detected by urine ketone tests. If enough ketones accumulate in the blood, they can cause a potentially life-threatening chemical imbalance known as ketoacidosis. The symptoms of ketoacidosis include nausea, vomiting, tiredness, frequent urination, and a fruity odor to the breath. Anyone with symptoms of ketoacidosis should seek medical help immediately. Ketoacidosis is often what causes people to first be diagnosed with Type 1 diabetes: Beta cells in the pancreas stop making enough insulin, thus preventing body cells from getting energy in the form of glucose. The body responds by burning fats for fuel, creating an excess of ketones in the blood. As dehydration also sets in, the person develops ketoacidosis. The nausea and vomiting that accompany ketoacidosis are sometimes mistaken for the symptoms of a bad flu. People with diabetes, particularly those with Type 1 diabetes, are at increased risk of ketoacidosis when they are sick. The stress of illness tends to raise blood glucose levels. But since illness often decreases a person’s appetite, resulting in less food intake than usual, some people mistakenly decrease their insulin dosages. In fact, increased amounts of insulin are often needed when a person is sick. Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Diabetes mellitus is the name given to a group of conditions whose common hallmark is a raised blood glucose concentration (hyperglycemia) due to an absolute or relative deficiency of the pancreatic hormone insulin. In the UK there are 1.4 million registered diabetic patients, approximately 3 % of the population. In addition, an estimated 1 million remain undiagnosed. It is a growing health problem: In 1998, the World Health Organization (WHO) predicted a doubling of the worldwide prevalence of diabetes from 150 million to 300 million by 2025. For a very tiny minority, diabetes is a secondary feature of primary endocrine disease such as acromegaly (growth hormone excess) or Cushing’s syndrome (excess corticosteroid), and for these patients successful treatment of the primary disease cures diabetes. Most diabetic patients, however, are classified as suffering either type 1 or type 2 diabetes. Type 1 diabetes Type 1 diabetes, which accounts for around 15 % of the total diabetic population, is an autoimmune disease of the pancreas in which the insulin-producing β-cells of the pancreas are selectively destroyed, resulting in an absolute insulin deficiency. The condition arises in genetically susceptible individuals exposed to undefined environmental insult(s) (possibly viral infection) early in life. It usually becomes clinically evident and therefore diagnosed during late childhood, with peak incidence between 11 and 13 years of age, although the autoimmune-mediated β-cell destruction begins many years earlier. There is currently no cure and type 1 diabetics have an absolute life-long requirement for daily insulin injections to survive. Type 2 diabetes This is the most common form of diabetes: around 85 % of the diabetic population has type 2 diabetes. The primary prob Continue reading >>

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