diabetestalk.net

How Does Ketoacidosis Cause Confusion

Metabolic Acidosis

Metabolic Acidosis

Metabolic acidosis occurs when the body produces too much acid. It can also occur when the kidneys are not removing enough acid from the body. There are several types of metabolic acidosis. Diabetic acidosis develops when acidic substances, known as ketone bodies, build up in the body. This most often occurs with uncontrolled type 1 diabetes. It is also called diabetic ketoacidosis and DKA. Hyperchloremic acidosis results from excessive loss of sodium bicarbonate from the body. This can occur with severe diarrhea. Lactic acidosis results from a buildup of lactic acid. It can be caused by: Alcohol Cancer Exercising intensely Liver failure Medicines, such as salicylates Other causes of metabolic acidosis include: Kidney disease (distal renal tubular acidosis and proximal renal tubular acidosis) Poisoning by aspirin, ethylene glycol (found in antifreeze), or methanol Continue reading >>

Ketosis Vs. Ketoacidosis: What You Should Know

Ketosis Vs. Ketoacidosis: What You Should Know

Despite the similarity in name, ketosis and ketoacidosis are two different things. Ketoacidosis refers to diabetic ketoacidosis (DKA) and is a complication of type 1 diabetes mellitus. It’s a life-threatening condition resulting from dangerously high levels of ketones and blood sugar. This combination makes your blood too acidic, which can change the normal functioning of internal organs like your liver and kidneys. It’s critical that you get prompt treatment. DKA can occur very quickly. It may develop in less than 24 hours. It mostly occurs in people with type 1 diabetes whose bodies do not produce any insulin. Several things can lead to DKA, including illness, improper diet, or not taking an adequate dose of insulin. DKA can also occur in individuals with type 2 diabetes who have little or no insulin production. Ketosis is the presence of ketones. It’s not harmful. You can be in ketosis if you’re on a low-carbohydrate diet or fasting, or if you’ve consumed too much alcohol. If you have ketosis, you have a higher than usual level of ketones in your blood or urine, but not high enough to cause acidosis. Ketones are a chemical your body produces when it burns stored fat. Some people choose a low-carb diet to help with weight loss. While there is some controversy over their safety, low-carb diets are generally fine. Talk to your doctor before beginning any extreme diet plan. DKA is the leading cause of death in people under 24 years old who have diabetes. The overall death rate for ketoacidosis is 2 to 5 percent. People under the age of 30 make up 36 percent of DKA cases. Twenty-seven percent of people with DKA are between the ages of 30 and 50, 23 percent are between the ages of 51 and 70, and 14 percent are over the age of 70. Ketosis may cause bad breath. Ket Continue reading >>

When There Are Acute Changes In Mental Status In Patients With Diabetes

When There Are Acute Changes In Mental Status In Patients With Diabetes

Author(s): Adam Lang, BS, and Kathleen Satterfield, DPM, FACFAOM As podiatric physicians in 2010, we are better trained than ever to manage patients’ problems. Even more importantly, we are well versed in making appropriate, well-timed referrals when needed. In the following case study, that particular acumen was critically important. A 78-year-old male with type 2 diabetes underwent resection of the first metatarsophalangeal base and debridement of an underlying ulcer, which has at times been infected. The plan was to inspect the bone for osteomyelitis, place the patient on oral antibiotics and not primarily close the plantar lesion, but pack it open instead. Resection of the phalangeal base would ease the deforming hallux interphalangeus. Examination revealed a hallux limitus and the physician determined that at the patient’s age and activity level, a Keller arthroplasty would serve him well, preventing further breakdown and possible osteomyelitis. The plantar lesion did not undergo primary closure but physicians packed it instead. The hospital discharged the patient within a week after bone cultures and histology showed no evidence of osteomyelitis. He received a prescription for oral antibiotics and received instruction to keep a clinic appointment in 48 hours. However, he was a no-show for his appointment. Phone calls to his home, all of which were documented, went unanswered over a period of two weeks. About a month after his discharge from the hospital, the patient went to the emergency department of the hospital accompanied by his wife. His extremity was in the same dressing he received upon preparation for discharge although now it was soiled and loose. His wife reported that they had never filled the prescription for antibiotics because they “did not und Continue reading >>

Diabetic Ketoacidosis Causes, Symptoms, Treatment, And Complications

Diabetic Ketoacidosis Causes, Symptoms, Treatment, And Complications

Diabetic ketoacidosis definition and facts Diabetic ketoacidosis is a life-threatening complication of type 1 diabetes (though rare, it can occur in people with type 2 diabetes) that occurs when the body produces high levels of ketones due to lack of insulin. Diabetic ketoacidosis occurs when the body cannot produce enough insulin. The signs and symptoms of diabetic ketoacidosis include Risk factors for diabetic ketoacidosis are type 1 diabetes, and missing insulin doses frequently, or being exposed to a stressor requiring higher insulin doses (infection, etc). Diabetic ketoacidosis is diagnosed by an elevated blood sugar (glucose) level, elevated blood ketones and acidity of the blood (acidosis). The treatment for diabetic ketoacidosis is insulin, fluids and electrolyte therapy. Diabetic ketoacidosis can be prevented by taking insulin as prescribed and monitoring glucose and ketone levels. The prognosis for a person with diabetic ketoacidosis depends on the severity of the disease and the other underlying medical conditions. Diabetic ketoacidosis (DKA) is a severe and life-threatening complication of diabetes. Diabetic ketoacidosis occurs when the cells in our body do not receive the sugar (glucose) they need for energy. This happens while there is plenty of glucose in the bloodstream, but not enough insulin to help convert glucose for use in the cells. The body recognizes this and starts breaking down muscle and fat for energy. This breakdown produces ketones (also called fatty acids), which cause an imbalance in our electrolyte system leading to the ketoacidosis (a metabolic acidosis). The sugar that cannot be used because of the lack of insulin stays in the bloodstream (rather than going into the cell and provide energy). The kidneys filter some of the glucose (suga 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 >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Initial Evaluation Initial evaluation of patients with DKA includes diagnosis and treatment of precipitating factors (Table 14–18). The most common precipitating factor is infection, followed by noncompliance with insulin therapy.3 While insulin pump therapy has been implicated as a risk factor for DKA in the past, most recent studies show that with proper education and practice using the pump, the frequency of DKA is the same for patients on pump and injection therapy.19 Common causes by frequency Other causes Selected drugs that may contribute to diabetic ketoacidosis Infection, particularly pneumonia, urinary tract infection, and sepsis4 Inadequate insulin treatment or noncompliance4 New-onset diabetes4 Cardiovascular disease, particularly myocardial infarction5 Acanthosis nigricans6 Acromegaly7 Arterial thrombosis, including mesenteric and iliac5 Cerebrovascular accident5 Hemochromatosis8 Hyperthyroidism9 Pancreatitis10 Pregnancy11 Atypical antipsychotic agents12 Corticosteroids13 FK50614 Glucagon15 Interferon16 Sympathomimetic agents including albuterol (Ventolin), dopamine (Intropin), dobutamine (Dobutrex), terbutaline (Bricanyl),17 and ritodrine (Yutopar)18 DIFFERENTIAL DIAGNOSIS Three key features of diabetic acidosis are hyperglycemia, ketosis, and acidosis. The conditions that cause these metabolic abnormalities overlap. The primary differential diagnosis for hyperglycemia is hyperosmolar hyperglycemic state (Table 23,20), which is discussed in the Stoner article21 on page 1723 of this issue. Common problems that produce ketosis include alcoholism and starvation. Metabolic states in which acidosis is predominant include lactic acidosis and ingestion of drugs such as salicylates and methanol. Abdominal pain may be a symptom of ketoacidosis or part of the inci Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a serious problem that can occur in people with diabetes if their body starts to run out of insulin. This causes harmful substances called ketones to build up in the body, which can be life-threatening if not spotted and treated quickly. DKA mainly affects people with type 1 diabetes, but can sometimes occur in people with type 2 diabetes. If you have diabetes, it's important to be aware of the risk and know what to do if DKA occurs. Symptoms of diabetic ketoacidosis Signs of DKA include: needing to pee more than usual being sick breath that smells fruity (like pear drop sweets or nail varnish) deep or fast breathing feeling very tired or sleepy passing out DKA can also cause high blood sugar (hyperglycaemia) and a high level of ketones in your blood or urine, which you can check for using home-testing kits. Symptoms usually develop over 24 hours, but can come on faster. Check your blood sugar and ketone levels Check your blood sugar level if you have symptoms of DKA. If your blood sugar is 11mmol/L or over and you have a blood or urine ketone testing kit, check your ketone level. If you do a blood ketone test: lower than 0.6mmol/L is a normal reading 0.6 to 1.5mmol/L means you're at a slightly increased risk of DKA and should test again in a couple of hours 1.6 to 2.9mmol/L means you're at an increased risk of DKA and should contact your diabetes team or GP as soon as possible 3mmol/L or over means you have a very high risk of DKA and should get medical help immediately If you do a urine ketone test, a result of more than 2+ means there's a high chance you have DKA. When to get medical help Go to your nearest accident and emergency (A&E) department straight away if you think you have DKA, especially if you have a high level of ketones in Continue reading >>

The Emedicinehealth Doctors Ask About Diabetic Ketoacidosis:

The Emedicinehealth Doctors Ask About Diabetic Ketoacidosis:

A A A Diabetic Ketoacidosis (cont.) A person developing diabetic ketoacidosis may have one or more of these symptoms: excessive thirst or drinking lots of fluid, frequent urination, general weakness, vomiting, loss of appetite, confusion, abdominal pain, shortness of breath, a generally ill appearance, increased heart rate, low blood pressure, increased rate of breathing, and a distinctive fruity odor on the breath. If you have any form of diabetes, contact your doctor when you have very high blood sugars (generally more than 350 mg) or moderate elevations that do not respond to home treatment. At initial diagnosis your doctor should have provided you with specific rules for dosing your medication(s) and for checking your urinary ketone level whenever you become ill. If not, ask your health care practitioner to provide such "sick day rules." If you have diabetes and start vomiting, seek immediate medical attention. If you have diabetes and develop a fever, contact your health care practitioner. If you feel sick, check your urinary ketone levels with home test strips. If your urinary ketones are moderate or higher, contact your health care practitioner. People with diabetes should be taken to a hospital's emergency department if they appear significantly ill, dehydrated, confused, or very weak. Other reasons to seek immediate medical treatment include shortness of breath, chest pain, severe abdominal pain with vomiting, or high fever (above 101 F or 38.3 C). Continue Reading A A A Diabetic Ketoacidosis (cont.) The diagnosis of diabetic ketoacidosis is typically made after the health care practitioner obtains a history, performs a physical examination, and reviews the laboratory tests. Blood tests will be ordered to document the levels of sugar, potassium, sodium, and oth Continue reading >>

Diabetes Update: Acute Complications

Diabetes Update: Acute Complications

"Diabetes update: Acute complications" CE credit is no longer available for this article. Originally posted April 2001 MARJORIE CYPRESS, MS, C-ANP, CDE MARJORIE CYPRESS is a nurse practitioner and certified diabetes educator for Lovelace Health Systems, Albuquerque, N.M. Series Editor: Carolyn Robertson, RN, MSN, CDE KEY WORDS: acute complications, hyperglycemia, hypoglycemia, diabetic ketoacidosis, hyperosmolar hyperglycemic state, ketosis Critically high or low blood sugar in a patient with diabetes is a medical emergency. You'll need to be able to quickly identify and know how to manage the acute complications of diabetes to help a patient avoid a tragic outcome. Here's how. Jump to: Choose article section... Emergency treatment of acute complications of diabetes demands quick recognition of the problem and immediate intervention. High blood sugar can progress to diabetic ketoacidosis (DKA) in Type 1 diabetics, and hyperosmolar hyperglycemic state (HHS) in those with Type 2. But every diabetic patient taking a hypoglycemic agent is at risk for hypoglycemia, the most common—and most feared—complication. Here we'll review the pathophysiology behind DKA, HHS, and hypoglycemia; provide assessments that help distinguish one complication from another; and discuss emergency treatments and nursing strategies that can prevent a potentially fatal outcome. Too much sugar, too little insulin DKA, often referred to as diabetic coma, occurs when there's a profound lack of insulin in the body. Without insulin, the body can't use glucose for fuel. Cells starve as sugar accumulates. The blood becomes thick with sugar, which promotes osmotic diuresis. As the body loses water, the excess sugar spills into the urine, taking important electrolytes with it. Patients become thirsty and Continue reading >>

Type 2 Diabetes: 4 Signs Of Trouble

Type 2 Diabetes: 4 Signs Of Trouble

If your glucose levels get out of control, it can lead to serious diabetes problems. Knowing the signs of these diabetes conditions can help you take quick action to resolve them. Diabetes complications can occur if you don't regulate your blood sugar (glucose) levels properly. Blood sugar is produced in your liver and muscles, and most of the food you eat is converted into blood sugar. This is your body's source of energy, but when your blood sugar gets too high, diabetes is the result. Your pancreas produces the hormone insulin, which then carries blood sugar into your cells, where it’s stored and used for energy. When you develop insulin resistance, high levels of sugar build up in your blood instead of your cells and you start to experience signs and symptoms of diabetes. You may notice fatigue, hunger, increased thirst, blurred vision, infections that are slow to heal, pain and numbness in your feet or hands, and increased urination. For awhile, your pancreas will work to keep up with your body’s sugar demand by producing more insulin, but eventually it loses the ability to compensate and serious diabetes complications — including blindness, kidney failure, loss of circulation in your lower extremities, and heart disease — can develop. For most people with diabetes, the target blood sugar level is 70 to 130 mg/dL, but your doctor will work with you to pinpoint your individual target range. Your doctor can also help you learn what to eat and how to keep your blood sugar within a healthy range. Joel Zonszein, MD, director of clinical diabetes at Montefiore Medical Center in New York City, says it’s very important to work with and see your doctor regularly and to consult a diabetes educator. If your diabetes is well-controlled and you're monitoring your bloo Continue reading >>

Diabetic Ketoacidosis (dka)

Diabetic Ketoacidosis (dka)

Tweet Diabetic ketoacidosis (DKA) is a dangerous complication faced by people with diabetes which happens when the body starts running out of insulin. DKA is most commonly associated with type 1 diabetes, however, people with type 2 diabetes that produce very little of their own insulin may also be affected. Ketoacidosis is a serious short term complication which can result in coma or even death if it is not treated quickly. Read about Diabetes and Ketones What is diabetic ketoacidosis? DKA occurs when the body has insufficient insulin to allow enough glucose to enter cells, and so the body switches to burning fatty acids and producing acidic ketone bodies. A high level of ketone bodies in the blood can cause particularly severe illness. Symptoms of DKA Diabetic ketoacidosis may itself be the symptom of undiagnosed type 1 diabetes. Typical symptoms of diabetic ketoacidosis include: Vomiting Dehydration An unusual smell on the breath –sometimes compared to the smell of pear drops Deep laboured breathing (called kussmaul breathing) or hyperventilation Rapid heartbeat Confusion and disorientation Symptoms of diabetic ketoacidosis usually evolve over a 24 hour period if blood glucose levels become and remain too high (hyperglycemia). Causes and risk factors for diabetic ketoacidosis As noted above, DKA is caused by the body having too little insulin to allow cells to take in glucose for energy. This may happen for a number of reasons including: Having blood glucose levels consistently over 15 mmol/l Missing insulin injections If a fault has developed in your insulin pen or insulin pump As a result of illness or infections High or prolonged levels of stress Excessive alcohol consumption DKA may also occur prior to a diagnosis of type 1 diabetes. Ketoacidosis can occasional Continue reading >>

What Is The Difference Between Hyperglycemia And Hypoglycemia?

What Is The Difference Between Hyperglycemia And Hypoglycemia?

By Debra A. Sokol-McKay, MS, CVRT, CDE, CLVT, OTR/L, SCLV What Is Hyperglycemia? In relation to diabetes, hyperglycemia refers to chronically high blood glucose levels. Most medical professionals define hyperglycemia by using the blood glucose goals that you and your physician have established and combining those goals with the blood glucose target ranges set by the American Diabetes Association. It's important to understand that you'll probably experience high blood glucose levels from time to time, despite your best efforts at control. As with any chronic disease, talk with your physician and diabetes care team if the pattern of your blood glucose readings is consistently higher or lower than your blood glucose goals. Complications from Hyperglycemia Persistent hyperglycemia can cause a wide range of chronic complications that affect almost every system in your body. When large blood vessels are affected, it can lead to: Stroke (cerebral vascular disease) Heart attack or Congestive Heart Failure (coronary heart disease) Circulation disorders and possible amputation (peripheral vascular disease) When smaller blood vessels are affected, it can lead to: Kidney disease (nephropathy) Nerve damage (neuropathy) Diabetic eye disease (retinopathy) Joseph Monks: Writer, Producer, and Film Director Joseph Monks, who has diabetic retinopathy, creates and produces films for his production company Sight Unseen Pictures. He is also the first blind filmmaker to direct a feature film. Says Joe, "I'm not uncomfortable with the term 'blind.' I'm not thrilled about it, of course, but it's accurate. The lights went out for me in early 2002 as a result of diabetic retinopathy—the death of my retinas. It is what it is, so when it happened, I decided that I wasn't going to let it put an en Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

The Facts Diabetic ketoacidosis (DKA) is a condition that may occur in people who have diabetes, most often in those who have type 1 (insulin-dependent) diabetes. It involves the buildup of toxic substances called ketones that make the blood too acidic. High ketone levels can be readily managed, but if they aren't detected and treated in time, a person can eventually slip into a fatal coma. DKA can occur in people who are newly diagnosed with type 1 diabetes and have had ketones building up in their blood prior to the start of treatment. It can also occur in people already diagnosed with type 1 diabetes that have missed an insulin dose, have an infection, or have suffered a traumatic event or injury. Although much less common, DKA can occasionally occur in people with type 2 diabetes under extreme physiologic stress. Causes With type 1 diabetes, the pancreas is unable to make the hormone insulin, which the body's cells need in order to take in glucose from the blood. In the case of type 2 diabetes, the pancreas is unable to make sufficient amounts of insulin in order to take in glucose from the blood. Glucose, a simple sugar we get from the foods we eat, is necessary for making the energy our cells need to function. People with diabetes can't get glucose into their cells, so their bodies look for alternative energy sources. Meanwhile, glucose builds up in the bloodstream, and by the time DKA occurs, blood glucose levels are often greater than 22 mmol/L (400 mg/dL) while insulin levels are very low. Since glucose isn't available for cells to use, fat from fat cells is broken down for energy instead, releasing ketones. Ketones accumulate in the blood, causing it to become more acidic. As a result, many of the enzymes that control the body's metabolic processes aren't able Continue reading >>

Diabetic Ketoacidosis (dka)

Diabetic Ketoacidosis (dka)

Diabetic Ketoacidosis (DKA) Diabetic ketoacidosis (DKA) occurs when the body does not have enough insulin. Insulin is what breaks down sugar into energy. When insulin is not present to break down sugars, our body begins to break down fat. Fat break down produces ketones which spill into the urine and cause glucose build up in the blood, thus acidifying the body. Because sugar is not entering into our body’s cells for energy breakdown, the sugar is being processed by the kidneys and excreted through the urine; as a result, we become dehydrated and our blood becomes even more acidic. This leads to sickness and hospitalization if not treated. If a person’s blood sugar is over 240, they should start checking their blood for ketones. If you have diabetes, or love someone who does, being aware of warning signs of diabetic ketoacidosis (DKA) can help save a life. Early Symptoms of DKA: High blood glucose level, usually > 300 High volume to ketones present in blood or urine Frequent urination or thirst that lasts for a day or more Dry skin and mouth Rapid shallow breathing Abdominal pain (especially in children) Muscle stiffness or aches Flushed face As DKA Worsens: Decreases alertness, confusion – brain is dehydrating Deep, labored, and gasping breathing Headache Breath that smells fruity or like fingernail polish remover Nausea and/or vomiting Abdomen may be tender and hurt if touched Decreased consciousness, coma, death If you think you might have DKA, test for ketones. If ketones are present, call your health care provider right away. To treat high blood sugar, hydrate with water or sugar free, caffeine free drinks. Sugar free popsicles and snacks are also good alternatives. Always call the doctor if vomiting goes on for more than two hours. Symptoms can go from mild Continue reading >>

Understanding The Presentation Of Diabetic Ketoacidosis

Understanding The Presentation Of Diabetic Ketoacidosis

Hypoglycemia, diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar nonketotic syndrome (HHNS) must be considered while forming a differential diagnosis when assessing and managing a patient with an altered mental status. This is especially true if the patient has a history of diabetes mellitus (DM). However, be aware that the onset of DKA or HHNS may be the first sign of DM in a patient with no known history. Thus, it is imperative to obtain a blood glucose reading on any patient with an altered mental status, especially if the patient appears to be dehydrated, regardless of a positive or negative history of DM. In addition to the blood glucose reading, the history — particularly onset — and physical assessment findings will contribute to the formulation of a differential diagnosis and the appropriate emergency management of the patient. Pathophysiology of DKA The patient experiencing DKA presents significantly different from one who is hypoglycemic. This is due to the variation in the pathology of the condition. Like hypoglycemia, by understanding the basic pathophysiology of DKA, there is no need to memorize signs and symptoms in order to recognize and differentiate between hypoglycemia and DKA. Unlike hypoglycemia, where the insulin level is in excess and the blood glucose level is extremely low, DKA is associated with a relative or absolute insulin deficiency and a severely elevated blood glucose level, typically greater than 300 mg/dL. Due to the lack of insulin, tissue such as muscle, fat and the liver are unable to take up glucose. Even though the blood has an extremely elevated amount of circulating glucose, the cells are basically starving. Because the blood brain barrier does not require insulin for glucose to diffuse across, the brain cells are rece Continue reading >>

More in ketosis