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How Ketoacidosis Cause Coma

Diabetic Ketoacidosis And Hyperglycaemic Hyperosmolar State

Diabetic Ketoacidosis And Hyperglycaemic Hyperosmolar State

The hallmark of diabetes is a raised plasma glucose resulting from an absolute or relative lack of insulin action. Untreated, this can lead to two distinct yet overlapping life-threatening emergencies. Near-complete lack of insulin will result in diabetic ketoacidosis, which is therefore more characteristic of type 1 diabetes, whereas partial insulin deficiency will suppress hepatic ketogenesis but not hepatic glucose output, resulting in hyperglycaemia and dehydration, and culminating in the hyperglycaemic hyperosmolar state. Hyperglycaemia is characteristic of diabetic ketoacidosis, particularly in the previously undiagnosed, but it is the acidosis and the associated electrolyte disorders that make this a life-threatening condition. Hyperglycaemia is the dominant feature of the hyperglycaemic hyperosmolar state, causing severe polyuria and fluid loss and leading to cellular dehydration. Progression from uncontrolled diabetes to a metabolic emergency may result from unrecognised diabetes, sometimes aggravated by glucose containing drinks, or metabolic stress due to infection or intercurrent illness and associated with increased levels of counter-regulatory hormones. Since diabetic ketoacidosis and the hyperglycaemic hyperosmolar state have a similar underlying pathophysiology the principles of treatment are similar (but not identical), and the conditions may be considered two extremes of a spectrum of disease, with individual patients often showing aspects of both. Pathogenesis of DKA and HHS Insulin is a powerful anabolic hormone which helps nutrients to enter the cells, where these nutrients can be used either as fuel or as building blocks for cell growth and expansion. The complementary action of insulin is to antagonise the breakdown of fuel stores. Thus, the relea Continue reading >>

Diabetic Coma

Diabetic Coma

Print Overview A diabetic coma is a life-threatening diabetes complication that causes unconsciousness. If you have diabetes, dangerously high blood sugar (hyperglycemia) or dangerously low blood sugar (hypoglycemia) can lead to a diabetic coma. If you lapse into a diabetic coma, you're alive — but you can't awaken or respond purposefully to sights, sounds or other types of stimulation. Left untreated, a diabetic coma can be fatal. The prospect of a diabetic coma is scary, but fortunately you can take steps to help prevent it. Start by following your diabetes treatment plan. Symptoms Before developing a diabetic coma, you'll usually experience signs and symptoms of high blood sugar or low blood sugar. High blood sugar (hyperglycemia) If your blood sugar level is too high, you may experience: Increased thirst Frequent urination Fatigue Nausea and vomiting Shortness of breath Stomach pain Fruity breath odor A very dry mouth A rapid heartbeat Low blood sugar (hypoglycemia) Signs and symptoms of a low blood sugar level may include: Shakiness or nervousness Anxiety Fatigue Weakness Sweating Hunger Nausea Dizziness or light-headedness Difficulty speaking Confusion Some people, especially those who've had diabetes for a long time, develop a condition known as hypoglycemia unawareness and won't have the warning signs that signal a drop in blood sugar. If you experience any symptoms of high or low blood sugar, test your blood sugar and follow your diabetes treatment plan based on the test results. If you don't start to feel better quickly, or you start to feel worse, call for emergency help. When to see a doctor A diabetic coma is a medical emergency. If you feel extreme high or low blood sugar signs or symptoms and think you might pass out, call 911 or your local emergency nu Continue reading >>

Cranberry Sparkler

Cranberry Sparkler

A state of profound unconsciousness from which a person cannot be aroused. It may be the result of trauma, a brain tumor, loss of blood supply to the brain (as from cerebrovascular disease), a toxic metabolic condition, or encephalitis (brain inflammation) from an infectious disease. In people with diabetes, two conditions associated with very high blood glucose may cause coma; these are diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS). Severe hypoglycemia, or very low blood glucose, may also lead to coma. It’s important for all people with diabetes to learn to recognize these conditions and respond accordingly. Diabetic ketoacidosis is a serious imbalance in blood chemistry causing about 100,000 hospitalizations each year, with a mortality rate of under 5%. It typically occurs when a person has high blood sugar and insufficient insulin to handle it. Without adequate insulin, the body breaks down fat cells for energy, flooding the bloodstream with metabolic by-products called ketoacids. Meanwhile, the kidneys begin filtering large amounts of glucose from the blood and producing large amounts of urine. As the person urinates more frequently, the body becomes dehydrated and loses important minerals called electrolytes. If not treated, these serious imbalances can eventually lead to coma and death. Hyperosmolar hyperglycemic state most commonly affects elderly people. Like DKA, HHS starts with high blood glucose and insulin deficiency and causes people to urinate frequently and become dehydrated. HHS also impairs the ability of the kidneys to filter glucose from the bloodstream, making the blood glucose level rise even higher. Because of the extreme dehydration, HHS can be life-threatening, with a mortality rate of 15%, and can be even more difficul 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

Practice Essentials Diabetic ketoacidosis (DKA) is an acute, major, life-threatening complication of diabetes that mainly occurs in patients with type 1 diabetes, but it is not uncommon in some patients with type 2 diabetes. This condition is a complex disordered metabolic state characterized by hyperglycemia, ketoacidosis, and ketonuria. Signs and symptoms The most common early symptoms of DKA are the insidious increase in polydipsia and polyuria. The following are other signs and symptoms of DKA: Nausea and vomiting; may be associated with diffuse abdominal pain, decreased appetite, and anorexia History of failure to comply with insulin therapy or missed insulin injections due to vomiting or psychological reasons or history of mechanical failure of insulin infusion pump Altered consciousness (eg, mild disorientation, confusion); frank coma is uncommon but may occur when the condition is neglected or with severe dehydration/acidosis Signs and symptoms of DKA associated with possible intercurrent infection are as follows: See Clinical Presentation for more detail. Diagnosis On examination, general findings of DKA may include the following: Characteristic acetone (ketotic) breath odor In addition, evaluate patients for signs of possible intercurrent illnesses such as MI, UTI, pneumonia, and perinephric abscess. Search for signs of infection is mandatory in all cases. Testing Initial and repeat laboratory studies for patients with DKA include the following: Serum electrolyte levels (eg, potassium, sodium, chloride, magnesium, calcium, phosphorus) Note that high serum glucose levels may lead to dilutional hyponatremia; high triglyceride levels may lead to factitious low glucose levels; and high levels of ketone bodies may lead to factitious elevation of creatinine levels. Continue reading >>

Ketoacidosis And Hyperosmolar Coma

Ketoacidosis And Hyperosmolar Coma

There are two acute conditions that can develop from the combination of high blood sugars and dehydration. The first is called diabetic ketoacidosis, or DKA. It occurs in people who make virtually no insulin on their own (either type 1 diabetics or type 2 diabetics who have lost nearly all beta cell activity). Very low serum insulin levels, combined with the insulin resistance caused by high blood sugars and dehydration, result in the virtual absence of insulin-mediated glucose transport to the tissues of the body. In the absence of adequate insulin, the body metabolizes stored fats to produce the energy that tissues require to remain alive. A by-product of fat metabolism is the production of substances called ketones and ketoacids. One of the ketones, acetone, is familiar as the major component of nail polish remover. Ketones may be detected in the urine by using a dipstick such as Ketostix (see Chapter 3, “Your Diabetic Tool Kit”). Ketones may also be detected on the breath as the aroma of an organic solvent, which is why unconscious diabetics are often mistaken for passed-out drunks. Ketones and ketoacids are toxic in large amounts. More important, your kidneys will try to eliminate them with even more urine, thereby causing further dehydration. Some of the hallmarks of severe ketoacidosis are large amounts of ketones in the urine, extreme thirst, dry mouth, nausea, frequent urination, deep labored breathing, and high blood sugar (usually over 350 mg/dl). The other acute complication of high blood sugar and dehydration, hyperosmolar coma, is a potentially more severe condition, and occurs in people whose beta cells still make some insulin. (“Hyperosmolar” refers to high concentrations of glucose, sodium, and chloride in the blood due to inadequate water to di Continue reading >>

Diabetic Emergencies (ketoacidosis And Coma)

Diabetic Emergencies (ketoacidosis And Coma)

The blood glucose (sugar) level is maintained with a narrow range that is sufficient for the cells to have an adequate supply of nutrition for energy production. High glucose levels can damage or even destroy cells over time while low levels will prevent cells from functioning optimally and lead to key systems in the body shutting down. Glucose like all other nutrients are derived from the food we eat. The food is digested and absorbed within the alimentary tract that runs from the mouth to the anus. The stomach and intestines (gastrointestinal tract) are the main sites for digestion and absorption. The nutrients then enter the bloodstream and travel to the liver where it is processed further. Other organs like the pancreas play a role in managing the nutrient levels within the body and its availability to the body’s cells. The pancreas specifically impacts on the blood glucose levels by secreting the hormone insulin which lowers blood glucose levels by promoting the cells to take up more glucose from the bloodstream and stimulating the liver to convert the glucose into other storage forms like glycogen and even fat. What is a diabetic emergency? Diabetes mellitus is a clinical condition which is characterized by high blood sugar levels (hyperglycemia) due to absolute (type 1 diabetes) or relative (type 2 diabetes) deficiency of insulin. This means that the body lacks insulin, secretes too little insulin or the body cells becomes resistant to the effects of insulin. The elevated blood glucose levels gradually diminishes different cells and organs. Diabetic emergencies can occur due to very high or very low blood sugar levels (hypoglycemia). They may arise in a person undergoing diabetes treatment but can also occur in new diabetic cases. Types of Diabetic Emergencies 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 Coma

Diabetic Coma

A diabetic coma is a life-threatening diabetes complication that causes unconsciousness. If you have diabetes, dangerously high blood sugar (hyperglycemia) or dangerously low blood sugar (hypoglycemia) can lead to a diabetic coma. If you lapse into a diabetic coma, you're alive — but you can't awaken or respond purposefully to sights, sounds or other types of stimulation. Left untreated, a diabetic coma can be fatal. The prospect of a diabetic coma is scary, but fortunately you can take steps to help prevent it. Start by following your diabetes treatment plan. Before developing a diabetic coma, you'll usually experience signs and symptoms of high blood sugar or low blood sugar. High blood sugar (hyperglycemia) If your blood sugar level is too high, you may experience: Increased thirst Frequent urination Fatigue Nausea and vomiting Shortness of breath Stomach pain Fruity breath odor A very dry mouth A rapid heartbeat Low blood sugar (hypoglycemia) Signs and symptoms of a low blood sugar level may include: Shakiness or nervousness Anxiety Fatigue Weakness Sweating Hunger Nausea Dizziness or light-headedness Difficulty speaking Confusion Some people, especially those who've had diabetes for a long time, develop a condition known as hypoglycemia unawareness and won't have the warning signs that signal a drop in blood sugar. If you experience any symptoms of high or low blood sugar, test your blood sugar and follow your diabetes treatment plan based on the test results. If you don't start to feel better quickly, or you start to feel worse, call for emergency help. When to see a doctor A diabetic coma is a medical emergency. If you feel extreme high or low blood sugar signs or symptoms and think you might pass out, call 911 or your local emergency number. If you're with som Continue reading >>

Diabetic Coma

Diabetic Coma

Diabetic coma is a medical emergency in which a person with diabetes loses consciousness because of one of the acute complications of diabetes: Advanced ketoacidosis from a combination of severe hyperglycemia, dehydration and shock, and exhaustion Hyperosmolar nonketotic state, in which extreme hyperglycemia and dehydration alone are enough to cause unconsciousness. Coma is a profound state of unconsciousness and a person in coma does not respond normally to pain or light, does not take any voluntary action, and does not exhibit the normal sleep-wake cycles. It may be a result of several conditions including including intoxication, metabolic abnormalities, central nervous system diseases, acute neurologic injuries such as stroke, and hypoxia. In some cases, it is deliberately induced by administering pharmaceutical agents with a view to preserve higher brain function following another form of brain trauma. Diabetic coma is a condition which may result as a severe complication of diabetes and may take three major forms of complications as indicated above, namely, hyperglycemia (high blood sugar), Diabetic ketoacidosis, and Hyperosmolar nonketotic state. In some case, even hypoglycemia (low blood sugar) may also trigger diabetic coma. Diabetic coma is largely preventable if proper medications as prescribed is taken along with having a healthy diet and maintaining a suitable lifestyle. At the same time, the blood sugar level should be monitored closely to indicate potential problems. Diabetic coma does not strike suddenly - it is preceded by a number warning signs and symptoms. In case of high blood sugar (hyperglycemia the person affected may experience one or more of these signs - frequent urination and increased thirst, dry mouth, vomiting and nausea, and shortness of b Continue reading >>

First Aid For Diabetic Coma

First Aid For Diabetic Coma

IMPORTANT INFORMATION: Read This First All incidents of Diabetic Coma should be evaluated by a trained medical professional, as soon as possible! DO NOT wait! Failure to obtain evaluation as soon as possible may result in serious injury or death. Call 911 (or your local emergency number) immediately, if you undergo a Diabetic Coma. What is Diabetic Coma? Diabetic Coma is a condition caused by extremely high blood sugar levels and low insulin production The condition is a medical emergency and prompt treatment is important What are the Causes of Diabetic Coma? The cause of Diabetic Coma may include: Excessive sugar or carbohydrate intake Skipped diabetes medication/insulin shot Very low blood glucose levels What are the Signs and Symptoms of Diabetic Coma? The onset of signs and symptoms of Diabetic Coma is generally spread over a prolonged period. It may include the following: Increased thirst Increased urination frequency Dehydration Drowsiness, confusion or irritation Increased breathing rate Sweet-smelling breath Loss of consciousness How is First Aid administered for Diabetic Coma? First Aid tips for Diabetic Coma: Call 911 or your local emergency help number immediately, for emergency assistance Try to assess, if the individual has taken their diabetes medication after a meal Ensure that the affected individual is lying in a position (lying straight) that can help easy breathing DO NOT give anything by way of mouth DO NOT administer an insulin shot Administer CPR, if the individual is in respiratory distress The first responders (healthcare personnel) may administer 1 mg of glucagon, in case of hypoglycemia (or low blood sugar levels). Who should administer First Aid for Diabetic Coma? Any individual near the affected person should call 911 (or the local emergency Continue reading >>

Your Intensive Care Hotline - Diabetic Coma

Your Intensive Care Hotline - Diabetic Coma

What is Diabetic Coma? Diabetic coma is a reversible form of coma found in people with diabetes mellitus. It is a medical emergency. Three different types of diabetic coma are identified: Severe diabetic hypoglycemia Diabetic ketoacidosis advanced enough to result in unconsciousness from a combination of severe hyperglycemia, dehydration and shock, and exhaustion Hyperosmolar nonketotic coma in which extreme hyperglycemia and dehydration alone are sufficient to cause unconsciousness. In most medical contexts, the term diabetic coma refers to the diagnostical dilemma posed when a physician is confronted with an unconscious Patient about whom nothing is known except that he has diabetes. An example might be a physician working in an emergency department who receives an unconscious Patient wearing a medical identification tag saying DIABETIC. Paramedics may be called to rescue an unconscious person by friends who identify him as diabetic. Brief descriptions of the three major conditions are followed by a discussion of the diagnostic process used to distinguish among them, as well as a few other conditions which must be considered. An estimated 2 to 15 percent of diabetics will suffer from at least one episode of diabetic coma in their lifetimes as a result of severe hypoglycemia. What is diabetes? Diabetic Ketoacidosis (DKA) Hyperosmolar Hypoglycemic Non-Ketotic Coma (HHNKC) Hypoglycemic Coma What happens In Intensive Care? How long will your loved one remain in Intensive Care? Internet Links What is Diabetes? Diabetes mellitus, or simply diabetes, is a group of metabolic diseases in which a person has high blood sugar, either because the pancreas does not produce enough insulin, or because cells do not respond to the insulin that is produced.This high blood sugar produces Continue reading >>

Diabetic Coma Causes

Diabetic Coma Causes

Diabetes also called diabetes mellitus is a life-long health condition that is caused by the problems in insulin hormone production in the body. Diabetes may cause health problems like blurred vision, kidney disease, weak immune system and also a life threatening condition diabetic coma. Diabetic coma may be caused by extremely high and extremely low blood sugar levels even blood sugar level may be higher than 600 mg/dL. These extreme high and low blood sugar levels may be caused by these conditions ; Diabetic ketoacidosis Diabetic ketoacidosis (DKA) occurs in type-1 diabetes if your muscles needs energy and can’t find enough insulin to use glucose and uses body fatty acids to produce energy. Ketones are produced as a result of this process and ketones are harmful for our body. Diabetic ketoacidosis is a life theratening condition. Diabetic hyperosmolar syndrome Diabetic hyperosmolar syndrome occurs if your blood sugar level is higher than 600 mg/dL. Also it can be caused by extreme dehydration.This very high sugar amount causes your blood to become more concentrated and thick. Body tries to remove this high sugar by urine and loses more water. Diabetic hyperosmolar syndrome must be treated as soon as possible. Hypoglycemia ( severe) Severe hypoglycemia ( low blood sugar) may be caused by too much insulin intake, drinking too much alcohol, strenous exercies. Hypoglycemia may cause loss of consciousness and diabetic coma. Diseases and surgery Some kind of diseases, surgery or trauma may cause hyperglycemia and diabetic ketoacidosis. This may be a reason of diabetic coma. Drugs Some kind of drugs may cause hyperglycemia and diabetic coma. Continue reading >>

Diabetic Coma

Diabetic Coma

Tweet Coma is relatively rare in diagnosed diabetes but it is very important to be aware of the situations that increase risk of coma. Causes of diabetic coma The main causes of coma occurring in people with diabetes are as a result of very low or very high blood glucose levels. The three most common causes of coma in people with diabetes are: Severe hypoglycemia and coma Severe hypoglycemia (very low blood glucose levels) can lead to loss of consciousness and coma if not treated. In most cases the body will restore blood sugar levels to normal by releasing glucagon to raise blood sugar levels. Coma is more likely to occur from low blood glucose levels if: A large insulin overdose is taken Alcohol is in the body during hypoglycemia Exercise has depleted the body’s glycogen supply Diabetic ketoacidosis and coma Diabetic ketoacidosis is a dangerous state of having very high blood glucose levels (typically above 17 mmol/L) in combination with high ketone levels. Ketoacidosis is able to occur if the body runs out of insulin and is therefore a factor for people with type 1 diabetes to be aware of. Insulin can prevent ketone levels rising and this is the key reason why people with diabetes are advised never to miss their long term (basal) insulin injections. The symptoms of ketoacidosis include nausea, vomiting, dehydration, disorientation and deep, laboured breathing. If someone with diabetes is displaying these symptoms call for emergency medical help as loss of consciousness and coma could follow. Illness in type 1 diabetes can lead to high blood glucose and ketone levels. It is advisable to test for ketones during periods of illness to prevent ketoacidosis developing. Diabetic coma at diagnosis of type 1 diabetes If the symptoms of type 1 diabetes are not spotted soon e Continue reading >>

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

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

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

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