Managing Diabetes Complicated By Ketoacidosis
Go to site For Pet Owners Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes mellitus that has to be aggressively treated. Diagnosis The diagnosis is based on the presence of ketonuria with signs of systemic illness. Management guidelines Goals of treatment include the correction of fluid deficits, acid-base balance and electrolyte balance, reduction of blood glucose and ketonuria, and beginning insulin therapy and treatment of concurrent diseases. Many protocols for treatment exist but rapid-acting insulin (regular) must be administered first, as decreases in the hyperglycemia must be achieved quickly. When blood sugar levels are lowered and maintained at 200−250 mg/dL for 4−10 hours, then Vetsulin® (porcine insulin zinc suspension) can be used. Evaluation of treatment When evaluating the regulation of insulin therapy, it is important to consider several areas including the evaluation of glycemia, urine monitoring, routine rechecks and glycated protein evaluations. Evaluation of the glycemia Creating a blood glucose curve is the most accurate way to evaluate glycemia in order to adjust the dose of Vetsulin. Indications for creating a blood glucose curve are: First, to establish insulin dose, dosing interval, and insulin type when beginning regulation. Second, to evaluate regulation especially if problems occur. Third, when rebound hyperglycemia (Somogyi effect) is suspected. Contraindications for creating a blood glucose curve are: Concurrent administration of drugs affecting glycemia. Presence of a known infection or disease. Stressed animal. The procedure is as follows: The most accurate way to assess response to management is by generating a blood glucose curve. Ideally, the first sample should be taken just prior to feeding Continue reading >>
Master Diabetic Ketoacidosis (dka) Diagnosis And Labs With Picmonic For Medicine
With Picmonic, facts become pictures. We've taken what the science shows - image mnemonics work - but we've boosted the effectiveness by building and associating memorable characters, interesting audio stories, and built-in quizzing. Dyed-bead-pancreas with Key-to-acidic-lemon and Diagnostic-computer with Test-tubes Picmonic Diabetic ketoacidosis (DKA) is a medical emergency and complication of diabetes. Patients have increased insulin requirements, which leads to a shortage. As a response, the body begins burning excess fat (and fatty acids), causing ketone body buildup Lab values seen in DKA include blood sugars above 250 mg/dL, and anion gap metabolic acidosis with pH below 7.3 and bicarbonate below 18. Patients will also show present plasma ketones. Due to an extracellular shift, patients may be hyperkalemic. Picmonic for Medicine (MD/DO) covers information that is relevant to your entire Medical (MD/DO) education. Whether you’re studying for your classes or getting ready to conquer the USMLE Step 1, USMLE Step 2 CK, COMLEX Level 1, or COMLEX Level 2, we’re here to help. Research shows that students who use Picmonic see a 331% improvement in memory retention and a 50% improvement in test scores. "[Picmonics] correlate directly with what is in First Aid so you know it is essential information that will show up on the exam. The number of questions I got right in biochemistry and microbiology were mainly due to this resource." James, Texas Tech University Health Sciences Center School of Medicine, 274 on Step 1 TRY IT FREE Continue reading >>
Diagnosis And Treatment Of Diabetic Ketoacidosis
Diabetic ketoacidosis (DKA) is the most frequent hyperglycaemic acute diabetic complication. Furthermore it carries a significant risk of death, which can be prevented by early and effective management. All physicians, irrespective of the discipline they are working in and whether in primary, secondary or tertiary care institutions, should be able to recognise DKA early and initiate management immediately. Continue reading >>
Original Article Ketoacidosis At Diagnosis Of Type 1 Diabetes In French Children And Adolescents
Abstract This study aimed to evaluate the frequency of diabetic ketoacidosis (DKA) and its associated factors at the diagnosis of type 1 diabetes (T1D) in French children and adolescents prior to launching a public-health campaign of information to prevent DKA. Over a 1-year period, 1299 youngsters (aged < 15 years) were diagnosed with T1D at 146 paediatric centres in all regions of France. Age, gender, duration of symptoms, patient's pathway to diagnosis, clinical and biological signs, and family history of T1D were collected for each newly diagnosed patient. DKA was defined as pH < 7.30 or bicarbonate < 15 mmol/L, and severe DKA as pH < 7.10 or bicarbonate < 5 mmol/L. At the time of diagnosis, 26% of the children were aged 0–5 years, 34% were 5–10 years and 40% were 10–15 years. The overall prevalence of DKA was 43.9% (0–5 years: 54.2%; 5–10 years: 43.4%; and 10–15 years: 37.1%) and 14.8% for severe DKA (0–5 years: 16.6%; 5–10 years: 14.4%; and 10–15 years: 13.9%; < 2 years: 25.3%). Severe DKA was more frequent when the child was hospitalized at the family's behest (26.6%) than when referred by a general practitioner (7.6%) or paediatrician (5.1%; 30.6%, 53.7% and 9.2%, respectively, by patients’ age group). The frequency of DKA decreased to 20.1% (severe DKA: 4.4%) in families with a history of T1D. Multivariate analysis showed that age, pathway to diagnosis, duration of polyuria/polydipsia (< 1 week) and family history of T1D were associated with the presence of DKA, while pathway to diagnosis and family history of T1D were associated with severe DKA. DKA at the time of T1D diagnosis in children and adolescents is frequent and often severe. Patients’ age, pathway to hospitalization and family history of diabetes were the main factors associated Continue reading >>
Can Serum Β-hydroxybutyrate Be Used To Diagnose Diabetic Ketoacidosis?
Abstract OBJECTIVE—Current criteria for the diagnosis of diabetic ketoacidosis (DKA) are limited by their nonspecificity (serum bicarbonate [HCO3] and pH) and qualitative nature (the presence of ketonemia/ketonuria). The present study was undertaken to determine whether quantitative measurement of a ketone body anion could be used to diagnose DKA. RESEARCH DESIGN AND METHODS—A retrospective review of records from hospitalized diabetic patients was undertaken to determine the concentration of serum β-hydroxybutyrate (βOHB) that corresponds to a HCO3 level of 18 mEq/l, the threshold value for diagnosis in recently published consensus criteria. Simultaneous admission βOHB and HCO3 values were recorded from 466 encounters, 129 in children and 337 in adults. RESULTS—A HCO3 level of 18 mEq/l corresponded with βOHB levels of 3.0 and 3.8 mmol/l in children and adults, respectively. With the use of these threshold βOHB values to define DKA, there was substantial discordance (∼≥20%) between βOHB and conventional diagnostic criteria using HCO3, pH, and glucose. In patients with DKA, there was no correlation between HCO3 and glucose levels on admission and a significant but weak correlation between βOHB and glucose levels (P < 0.001). CONCLUSIONS—Where available, serum βOHB levels ≥3.0 and ≥3.8 mmol/l in children and adults, respectively, in the presence of uncontrolled diabetes can be used to diagnose DKA and may be superior to the serum HCO3 level for that purpose. The marked variability in the relationship between βOHB and HCO3 is probably due to the presence of other acid-base disturbances, especially hyperchloremic, nonanion gap acidosis. Recently published consensus criteria for diagnosing diabetic ketoacidosis (DKA) include a serum bicarbonate (HCO3) Continue reading >>
Diagnosis And Treatment Of Diabetic Ketoacidosis (dka) In Dogs And Cats
What is DKA in Dogs and Cats? Diabetic Ketoacidosis (DKA) is a serious and life-threatening complication of diabetes mellitus that can occur in dogs and cats. DKA is characterized by hyperglycemia, ketonemia, +/- ketonuria, and metabolic acidosis. Ketone bodies are formed by lipolysis (breakdown) of fat and beta-oxidation when the metabolic demands of the cells are not met by the limited intracellular glucose concentrations. This provides alternative energy sources for cells, which are most important for the brain. The three ketones that are formed include beta-hydroxybutyrate, acetoacetate and acetone. Beta-hydroxybutyrate (BHB) and acetoacetate are anions of moderately strong acids contributing most to the academia (low blood pH). Acetone is the ketone body that can be detected on breath. In a normal animal, glucose enters the cell (with help of insulin) – undergoes glycolysis to pyruvate within cytosol – pyruvate moves into mitochondria (energy generating organelle in the cell) to enter the TCA cycle and ATP is formed. ATP is the main energy source of the body. When glucose cannot enter the cell, free fatty acids are broken down (lipolysis) and move into the cell to undergo beta-oxidation (creation of pyruvate). The pyruvate then moves into the mitochondria to enter the TCA cycle (by conversion to Acetyl-CoA first). However, when the TCA cycle is overwhelmed, the Acetyl-CoA is used in ketogenesis to form ketone bodies. Summary Diabetic Ketoacidosis (DKA) in Dogs and Cats When there is no insulin the body cannot utilize glucose and there is no intracellular glucose. The body then uses ketone bodes as an alternate source. When there is decreased insulin and increased counterregulatory hormones fatty acids are converted to AcCoA and then ketones. In the non-diabetic Continue reading >>
Print If your doctor suspects diabetic ketoacidosis, he or she will do a physical exam and various blood tests. In some cases, additional tests may be needed to help determine what triggered the diabetic ketoacidosis. Blood tests Blood tests used in the diagnosis of diabetic ketoacidosis will measure: Blood sugar level. If there isn't enough insulin in your body to allow sugar to enter your cells, your blood sugar level will rise (hyperglycemia). As your body breaks down fat and protein for energy, your blood sugar level will continue to rise. Ketone level. When your body breaks down fat and protein for energy, acids known as ketones enter your bloodstream. Blood acidity. If you have excess ketones in your blood, your blood will become acidic (acidosis). This can alter the normal function of organs throughout your body. Additional tests Your doctor may order tests to identify underlying health problems that might have contributed to diabetic ketoacidosis and to check for complications. Tests might include: Blood electrolyte tests Urinalysis Chest X-ray A recording of the electrical activity of the heart (electrocardiogram) Treatment If you're diagnosed with diabetic ketoacidosis, you might be treated in the emergency room or admitted to the hospital. Treatment usually involves: Fluid replacement. You'll receive fluids — either by mouth or through a vein (intravenously) — until you're rehydrated. The fluids will replace those you've lost through excessive urination, as well as help dilute the excess sugar in your blood. Electrolyte replacement. Electrolytes are minerals in your blood that carry an electric charge, such as sodium, potassium and chloride. The absence of insulin can lower the level of several electrolytes in your blood. You'll receive electrolytes throu Continue reading >>
How Many Separate Diagnoses Is A Typical Graduating Medical Student Trained To Make?
On paper? Probably close to a thousand or so. At least that's how many diseases and conditions are tested on standardized exams. But then again, those are exam questions, under incredibly artificial conditions, which rarely reflects what goes on in the real world. In reality, closer to zero. Interns (first year residents) are constantly under supervision, and can't make diagnoses by themselves. Obtaining a medical history, interpreting labs, and integrating everything in the context of that person's entire health history is a lot more complex than an exam problem which spoon feeds your findings in a very, very, specific manner. By the end of residency, and as you enter your chosen specialty, you probably only retain 1/10 of all the diseases you learned in medical school, maybe a little more if you remain a general practitioner. A neurologist will be very familiar with all the neurology-related diseases, but probably won't have a clue on how to diagnose or treat something like Brugada Syndrome, which is something a cardiologist would take care of. Medical school is necessary, but certainly not sufficient to be proficient at the diagnosis of disease. It sets up a foundation where you learn how to make a diagnosis; residency is where you practice and become proficient in these skills. Continue reading >>
What Is The Nursing Diagnosis For Hyperkalemia?
As is frequently the case with “what is the nursing diagnosis for X” questions on Quora, there is a disclaimer that must be made: This is a MEDICAL diagnosis. There are no nursing diagnoses for it. There are likely nursing diagnoses ASSOCIATED with it. Lets look at why it means to be hyperkalemic… or in laymen’s terms, having high potassium in your bloodstream. It means that somewhere, most likely in the gastrointestinal, renal, or endocrine systems a problem has occurred. Before we can figure out how to fix the kyperkalemia, we need to know WHY the patient is in this state. It it excessive intake? Diabetic ketoacidosis (DKA)? Renal failure? A licensed independent practitioner (LIP) will need to figure this one out for the nurse (or at least officially make the decision as it is out of the scope of the RN to make this call). The nursing role will be to support the medical diagnosis and selected interventions. This is where we start to see some nursing diagnosis actually emerge. IV access will most likely be needed. Associated nursing diagnosis: Risk for bleeding, risk for infection, risk for impaired healing, risk for altered body image. If this is a DKA issue, then it is possible the you can include: Need for further education, lack of effecting coping mechanisms, or even the dreaded and controversial Risk for noncompliance. Please note that your patients with diabetes (DM1, to be precise in this case) are not always in DKA because they have “failed” at their treatment regimen. DM is a complicated disease process and homeostatic imbalances can become a runaway nightmare that push even the most ardent adherents of blood sugar management into a very bad place. Also remember that they may be serum hyperkalemic on the labs, but are at high Risk for HYPOkalemia Continue reading >>
Diabetic Ketoacidosis: Diagnosis And Management.
Abstract The objective of this manuscript is to review the clinical manifestations, diagnosis and management of diabetic ketoacidosis, one of the most common acute complications of diabetes mellitus. We performed a medline search of the English-language literature using a combination of words (diabetic ketoacidosis, hyperglycemic crises) to identify original studies, consensus statements and reviews on diabetic ketoacidosis published in the past 15 years. Emphasis was placed on clinical manifestations of diabetic ketoacidosis, its diagnosis and treatment.Diabetic ketoacidosis (DKA) is an acute complication of diabetes mellitus that can be life-threatening if not treated properly. Once thought to occur only in patients with type 1 diabetes, diabetic ketoacidosis has also been observed in patients with type 2 diabetes under certain conditions. The basic underlying mechanism for diabetic ketoacidosis is insulin deficiency coupled with elevated levels of counterregulatory hormones, such as glucagon, cortisol, catecholamines, and growth hormone. Diabetic ketoacidosis can be the initial presentation of diabetes mellitus or precipitated in known patients with diabetes mellitus by many factors, most commonly infection. The management of diabetic ketoacidosis involves careful clinical evaluation, correction of metabolic abnormalities, identification and treatment of precipitating and co-morbid conditions, appropriate long-term treatment of diabetes, and plans to prevent recurrence. Many cases of DKA can be prevented by better access to medical care, proper education, and effective communication with a health care provider during intercurrent illness. Provision of guidelines will also reduce mortality. Resources need to be redirected towards prevention by funding better access to Continue reading >>
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 Ketoacidosis And Hyperglycemic Hyperosmolar Syndrome
In Brief Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic syndrome (HHS) are two acute complications of diabetes that can result in increased morbidity and mortality if not efficiently and effectively treated. Mortality rates are 2–5% for DKA and 15% for HHS, and mortality is usually a consequence of the underlying precipitating cause(s) rather than a result of the metabolic changes of hyperglycemia. Effective standardized treatment protocols, as well as prompt identification and treatment of the precipitating cause, are important factors affecting outcome. The two most common life-threatening complications of diabetes mellitus include diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar syndrome (HHS). Although there are important differences in their pathogenesis, the basic underlying mechanism for both disorders is a reduction in the net effective concentration of circulating insulin coupled with a concomitant elevation of counterregulatory hormones (glucagon, catecholamines, cortisol, and growth hormone). These hyperglycemic emergencies continue to be important causes of morbidity and mortality among patients with diabetes. DKA is reported to be responsible for more than 100,000 hospital admissions per year in the United States1 and accounts for 4–9% of all hospital discharge summaries among patients with diabetes.1 The incidence of HHS is lower than DKA and accounts for <1% of all primary diabetic admissions.1 Most patients with DKA have type 1 diabetes; however, patients with type 2 diabetes are also at risk during the catabolic stress of acute illness.2 Contrary to popular belief, DKA is more common in adults than in children.1 In community-based studies, more than 40% of African-American patients with DKA were >40 years of age and more than 2 Continue reading >>
What Are Some Unbelievable Er Stories?
The Emergency Department, like no other hospital department, is unique - mainly because 'all human life is there'. We have 'elastic walls', the lights are always on, and there is always someone there. So, as in the film The Field of Dreams, 'if you build it, they will come'. And they do, in their thousands. Some genuine, some not. The constant source of interest and amusement can be divided into various categories. Amongst my personal favourites are the :- Stuff Where it Shouldn't Be The man with an apple inserted into his rectum, apparently by accident after an unfortunate fall onto a fruit basket whilst vacuuming. Naked! Now, I may be naive, but I'm not stupid and this is not believable. The public also present with vibrators, toothpaste pump dispensers and various items of cutlery. These things are fairly amusing. The stories they tell about how the item got there, funnier still. Creatures and Creepy Crawlies One memorable day, a young lady arrived in the department weeping bitterly. She had, she told me, something in her bottom. Expecting a minor lump or spot, I asked her to lower her trousers. As I bent down to peer at the offending object, the offending object reared up to look back at me (it was a very large worm!) I vomited, Dr Dan (I have spoken of him previously) fainted! We have also had people attempting to insert small rodent like creatures into various bodily oriffii (not sure if that's a word but I think you get my gist!) Priapism Look it up! This is a persistent erection of the male organ. It can be caused by a spinal injury. One patient arrived with a history suggestive of such an injury. There was a large 'bulge' in his undergarments. We were worried, this was not a good thing. Sometimes 'it was there' sometimes 'it wasn't!' . A colleague was suspiciou Continue reading >>
- Unbelievable: Treat Diabetes, Asthma, Cholesterol And Kidney Diseases With Okra Water- Now You Can Make It Yourself
- Unbelievable: Treat Diabetes, Asthma, Cholesterol And Kidney Diseases With Okra Water- Now You Can Make It Yourself
- Unbelievable: Treat Diabetes, Asthma, Cholesterol, and Kidney Diseases with Okra Water-Now You Can Make It Yourself
Does It Mean My Child Is Diabetic, If His Breath Smells Of Urine?
In my years of nursing I've never heard of an untreated diabetic's breath smelling of urine.A diabetic not receiving insulin spills sugar out of their bloodstream into their urine giving it a sickly sweet smell. And taste according to old time doctor's. Before the creation of readily available test kits, old school doc's would dip their pinky in a cup of the patient's urine and taste it. If it was sweet like sugar water then a diagnosis of diabetes was a lock. You see, without insulin in being released from the pancreas the cells of the person with diabetes would not open receptors to take the sugar inside those cells where it's broken down in a process known as glycolysis. Glycolysis is one string of a longer reaction called cellular respiration. So the diabetic is left with cells lacking fuel and the bloodstream is loaded with fuel..sugar…with no place to put it. So the sugar leaves the body mostly through the persons urine, Now the cells of the person's body in a desperate attempt to keep glycolysis and cellular respiration going turn to the next available fuel fat. Fat will break down for fuel in a reaction called lipolysis. While not as efficient as glycolysis , it keeps things running temporarily but not forever which is why diabetes is a fatal illness if it's not treated. One of the byproducts of lipolysis is ketones. Ketones which are in the same chemical family as acetone and are known for a strong sickly sweet smell. The ketones being produced cause the persons blood PH to drop in a condition called ketoacidosis. During ketoacidosis the person's respirations increase and they blow off the ketones in their breath as they spill out of the diabetic's blood stream into their lungs. Their breath takes on a sickly sweet smell as does the person's urine. I'm wonder Continue reading >>
Diabetic Ketoacidosis In Dogs
My dog is diabetic. He has been doing pretty well overall, but recently he became really ill. He stopped eating well, started drinking lots of water, and got really weak. His veterinarian said that he had a condition called “ketoacidosis,” and he had to spend several days in the hospital. I’m not sure I understand this disorder. Diabetic ketoacidosis is a medical emergency that occurs when there is not enough insulin in the body to control blood sugar (glucose) levels. The body can’t use glucose properly without insulin, so blood glucose levels get very high, and the body creates ketone bodies as an emergency fuel source. When these are broken down, it creates byproducts that cause the body’s acid/base balance to shift, and the body becomes more acidic (acidosis), and it can’t maintain appropriate fluid balance. The electrolyte (mineral) balance becomes disrupted which can lead to abnormal heart rhythms and abnormal muscle function. If left untreated, diabetic ketoacidosis is fatal. How could this disorder have happened? If a diabetic dog undergoes a stress event of some kind, the body secretes stress hormones that interfere with appropriate insulin activity. Examples of stress events that can lead to diabetic ketoacidosis include infection, inflammation, and heart disease. What are the signs of diabetic ketoacidosis? The signs of diabetic ketoacidosis include: Excessive thirst/drinking Increased urination Lethargy Weakness Vomiting Increased respiratory rate Decreased appetite Weight loss (unplanned) with muscle wasting Dehydration Unkempt haircoat These same clinical signs can occur with other medical conditions, so it is important for your veterinarian to perform appropriate diagnostic tests to determine if diabetic ketoacidosis in truly the issue at hand Continue reading >>