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Is Diabetic Ketoacidosis Hypoglycemic Or Hyperglycemic?

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What is DIABETIC KETOACIDOSIS? What does DIABETIC KETOACIDOSIS mean? DIABETIC KETOACIDOSIS meaning - DIABETIC KETOACIDOSIS definition - DIABETIC KETOACIDOSIS explanation. Source: Wikipedia.org article, adapted under https://creativecommons.org/licenses/... license. SUBSCRIBE to our Google Earth flights channel - https://www.youtube.com/channel/UC6Uu... Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes mellitus. Signs and symptoms may include vomiting, abdominal pain, deep gasping breathing, increased urination, weakness, confusion, and occasionally loss of consciousness. A person's breath may develop a specific smell. Onset of symptoms is usually rapid. In some cases people may not realize they previously had diabetes. DKA happens most often in those with type 1 diabetes, but can also occur in those with other types of diabetes under certain circumstances. Triggers may include infection, not taking insulin correctly, stroke, and certain medications such as steroids. DKA results from a shortage of insulin; in response the body switches to burning fatty acids which produces acidic ketone bodies. DKA is typically diagnosed when testing finds high blood sugar, low blood pH, and ketoacids in either the blood or urine. The primary treatment of DKA is with intravenous fluids and insulin. Depending on the severity, insulin may be given intravenously or by injection under the skin. Usually potassium is also needed to prevent the development of low blood potassium. Throughout treatment blood sugar and potassium levels should be regularly checked. Antibiotics may be required in those with an underlying infection. In those with severely low blood pH, sodium bicarbonate may be given; however, its use is of unclear benefit and typically not recommended. Rates of DKA vary around the world. About 4% of people with type 1 diabetes in United Kingdom develop DKA a year, while in Malaysia the condition affects about 25% a year. DKA was first described in 1886 and, until the introduction of insulin therapy in the 1920s, it was almost universally fatal. The risk of death with adequate and timely treatment is currently around 1–4%. Up to 1% of children with DKA develop a complication known as cerebral edema. The symptoms of an episode of diabetic ketoacidosis usually evolve over a period of about 24 hours. Predominant symptoms are nausea and vomiting, pronounced thirst, excessive urine production and abdominal pain that may be severe. Those who measure their glucose levels themselves may notice hyperglycemia (high blood sugar levels). In severe DKA, breathing becomes labored and of a deep, gasping character (a state referred to as "Kussmaul respiration"). The abdomen may be tender to the point that an acute abdomen may be suspected, such as acute pancreatitis, appendicitis or gastrointestinal perforation. Coffee ground vomiting (vomiting of altered blood) occurs in a minority of people; this tends to originate from erosion of the esophagus. In severe DKA, there may be confusion, lethargy, stupor or even coma (a marked decrease in the level of consciousness). On physical examination there is usually clinical evidence of dehydration, such as a dry mouth and decreased skin turgor. If the dehydration is profound enough to cause a decrease in the circulating blood volume, tachycardia (a fast heart rate) and low blood pressure may be observed. Often, a "ketotic" odor is present, which is often described as "fruity", often compared to the smell of pear drops whose scent is a ketone. If Kussmaul respiration is present, this is reflected in an increased respiratory rate.....

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 bet Continue reading >>

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  1. PeeWeeMerman

    With the new year and new keto-ers, I'd like for you to learn from my mistake. I used to pay close attention to my macro ratios. DON'T. They don't matter.
    You're looking at GRAMS. The only way those ratios the keto calculator spits out are accurate are if you eat exactly at the number of recommended calories every day. If you eat more, you may go over the amount of protein you should be eating in a day when you keep the ratio. If you eat less, you won't get enough protein.
    1) Meet your protein goal. Don't exceed it or come in under it.
    2) Stay under your carb limit.
    3) Use fat for the rest. You could have lower fat or higher fat days, depending on how much of a deficit you're working with. There is no number to hit.
    Do not stick to the ratios. You don't need to "get in enough fat." Ever.
    *Edit: I'm not saying "don't follow your macros." Macros are critical! I'm saying don't measure your macros in percentages. The RATIO doesn't matter. The grams are what count. The ratio is variable and therefore unreliable to use as your guideline.

  2. ctuck239

    Carbs are a limit to stay below
    Protein is a goal to make you grow
    Fat is the fuel so you're not slow
    ...or something like that, credit /u/rickamore (I believe)

  3. rickamore

    You nailed it!

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DKA and HHS (HHNS) nursing NCLEX lecture review of the treatment, patient signs/symptoms, and management. Diabetic ketoacidosis and hyperosmolar hyperglycemia nonketotic syndrome are two complications that can present in diabetes mellitus. DKA is more common in type 1 diabetics, whereas, HHNS is more common in type 2 diabetics. Patients with diabetic ketoacidosis will present with ketosis and acidosis and signs/symptoms will include hyperglycemia (greater than 300 mg/dL), Kussmaul breathing, fruity (acetone breath), ketones in the urine, and metabolic acidosis. Patients with hyperglycemic hyperosmolar syndrome will NOT have ketosis or acidosis but EXTREME hyperglycemia (greater than 600 mg/dL). In addition, hyperosmolarity will present which will cause major osmotic diuresis and the patient will experience with severe dehydration. Quiz on DKA vs HHNS: http://www.registerednursern.com/dka-... Lecture Notes for this video: http://www.registerednursern.com/dka-... Diabetes NCLEX Review Series: https://www.youtube.com/playlist?list... Video on DKA (detailed lecture): https://www.youtube.com/watch?v=IxrCV... Video on HHNS (detailed lecture): https://www.youtube.com/watch?v=LyExA... Subscribe: http://www.youtube.com/subscription_c... Nursing School Supplies: http://www.registerednursern.com/the-... Nursing Job Search: http://www.registerednursern.com/nurs... Visit our website RegisteredNurseRN.com for free quizzes, nursing care plans, salary information, job search, and much more: http://www.registerednursern.com Check out other Videos: https://www.youtube.com/user/Register... Popular Playlists: "NCLEX Study Strategies": https://www.youtube.com/playlist?list... "Fluid & Electrolytes Made So Easy": https://www.youtube.com/playlist?list... "Nursing Skills Videos": https://www.youtube.com/playlist?list... "Nursing School Study Tips": https://www.youtube.com/playlist?list... "Nursing School Tips & Questions": https://www.youtube.com/playlist?list... "Teaching Tutorials": https://www.youtube.com/playlist?list... "Types of Nursing Specialties": https://www.youtube.com/playlist?list... "Healthcare Salary Information": https://www.youtube.com/playlist?list... "New Nurse Tips": https://www.youtube.com/playlist?list... "Nursing Career Help": https://www.youtube.com/playlist?list... "EKG Teaching Tutorials": https://www.youtube.com/playlist?list... "Personality Types": https://www.youtube.com/playlist?list... "Dosage & Calculations for Nurses": https://www.youtube.com/playlist?list... "Diabetes Health Managment": https://www.youtube.com/playlist?list...

Diabetic Emergencies - Ketoacidosis, Hyperglycaemic Hyperosmolar State And Hypoglycaemia.

Division of Endocrinology and Metabolism, Emory University School of Medicine, 49 Jesse Hill Jr Drive, Atlanta, Georgia 30303, USA. Division of Endocrinology and Metabolism, University of Pittsburgh, 3601 Fifth Avenue, Suite 560, Pittsburgh, Pennsylvania 15213, USA. Diabetic ketoacidosis (DKA), hyperglycaemic hyperosmolar state (HHS) and hypoglycaemia are serious complications of diabetes mellitus that require prompt recognition, diagnosis and treatment. DKA and HHS are characterized by insulinopaenia and severe hyperglycaemia; clinically, these two conditions differ only by the degree of dehydration and the severity of metabolic acidosis. The overall mortality recorded among children and adults with DKA is <1%. Mortality among patients with HHS is ~10-fold higher than that associated with DKA. The prognosis and outcome of patients with DKA or HHS are determined by the severity of dehydration, the presence of comorbidities and age >60 years. The estimated annual cost of hospital treatment for patients experiencing hyperglycaemic crises in the USA exceeds US$2 billion. Hypoglycaemia is a frequent and serious adverse effect of antidiabetic therapy that is associated with both immedi Continue reading >>

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  1. amsmith

    I understand that the guidelines state "uncontrolled" should be coded as hyperglycemia. What about the DKA type 2 portion? We have 2 opinions in our office and I am just looking for the correct way to code it.
    I suspect for my scenario E11.65, E11.69 and E87.2. Please help.
    There really should be an E11.1X...LOL!!
    Thank you,
    Anna

  2. mitchellde

    Ketoacidosis is actually rare in a type 2 diabetic so that may be the reason for no specific code for it. So use the E11.69 with the E87.2

  3. amsmith

    Oddly, our physician's document it frequently. I will check with one of them to find out why we tend to have a higher volume.

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DKA (Diabetic Ketoacidosis) Vs HHNS (Hyperosmolar Hyperglycemic Nonketotic Syndrome) Tables From Step Up to Medicine (3rd Edition, Agabegi) Here is the link for the Quick Hits =) http://imgur.com/TnJPBmu

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 fo Continue reading >>

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  1. Sting

    Just done a quick Google and here are some comments i read....
    - There's nothing magical about ketosis and you will still gain if energy in exceeds energy out. Ketosis is not neccessary for fatloss and you shouldn't put coconut and other fat sources everywhere. Focus on more protein from meat/eggs/dairy + green veggies and don't add any fats other than some fishoil. You'll be getting enough fats from your protein sources and don't have to worry about ketosis.
    - Damn. Thanks Manimal- I feel like kind of an idiot now for not assuming this, but ketosis gets such cred on this board! I mean, if weight on ketosis still equals energy in and energy out, what's all the fuss about?
    - Ketosis means that your body is using mostly fat for fuel. IF you are eating less energy than you burn, then yay, it'll be mostly stored fat that your body uses, and you will shrink. But if you are eating more energy, then you will still be laying down fat faster than you burn it. The win in ketosis is that most people are a lot less hungry. It does not add up to fat loss by itself.
    - If I go to ketosis I will usually undereat without planning to, because my appetite just shrinks. But this might not be true for you. And coconut is not a magic free fat loss food. The fats in it are easy to digest and it's a good choice for promoting ketosis, but if you eat enough of it, you can still get fatter on it.
    - It is possible to gain weight in ketosis - calories still matter
    Thoughts?

  2. Meli-Mel

    I think ketosis is part of the big picture, but not the only defining factor in weight loss.

  3. Dottie

    As you can tell reading this site alone, your mileage may vary
    Some people can eat as many calories as they like, others have to watch them.
    As with anything: everyone and everybody is different.
    __________________
    https://www.supertracker.usda.gov/default.aspx <--FDA tracking tools
    http://ndb.nal.usda.gov/ <--FDA nutritional counts
    http://www.onlineconversion.com/ <-- cooking and other conversions
    Need to contact LCF?
    http://www.lowcarbfriends.com/contact.html
    Everyone has an opinion. Take what you need and leave the rest.
    Be sure to visit Netrition on Facebook for the latest products and deals!
    https://www.facebook.com/Netritioncom-210889832433/
    **Every day is up to you. You can choose for it to be a good day or a bad day.**

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