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Is Ketoacidosis Life Threatening?

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 >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

What is diabetic ketoacidosis? Diabetic ketoacidosis (DKA) is a life-threatening condition caused by a build-up of waste products called ketones in the blood. It occurs in people with diabetes mellitus when they have no, or very low levels of, insulin. DKA mostly occurs in people with type 1 diabetes, but it can also occur in some people with type 2 diabetes and pregnant women with gestational diabetes. Causes Glucose is an essential energy source for the body's cells. When food containing carbohydrates is eaten, it is broken down into glucose that travels around the body in the blood, to be absorbed by cells that use it for energy. Insulin works to help glucose pass into cells. Without insulin, the cells cannot absorb glucose to use for energy. This leads to a series of changes in metabolism that can affect the whole body. The liver attempts to compensate for the lack of energy in the cells by producing more glucose, leading to increased levels of glucose in the blood, also known as hyperglycaemia. The body switches to burning its stores of fat instead of glucose to produce energy. This leads to a build-up of acidic waste products called ketones in the blood and urine. This is known as ketoacidosis, and it can cause heart rhythm abnormalities, breathing changes and abdominal pain. The kidneys try to remove some of the excess glucose and ketones. However, this requires taking large amounts of fluid from the body, which leads to dehydration. This can cause: Increased concentration of ketones in the blood, worsening the ketoacidosis; Loss of electrolytes such as potassium and salt that are vital for the normal function of the body's cells, and; Signs and symptoms Symptoms of DKA can develop over the course of hours. They can include: Increased thirst; Increased frequency Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Diabetic ketoacidosis is a potentially life-threatening complication of diabetes caused by a lack of insulin in the body. It's important to seek medical advice quickly if you think that you or your child is experiencing the condition. Causes of diabetic ketoacidosis Diabetic ketoacidosis is a complication of diabetes that can occur if the body starts to run out of insulin. It's common in people with type 1 diabetes and can very occasionally affect those with type 2 diabetes. It sometimes develops in people who were previously unaware they had diabetes. Children and young adults are most at risk. Insulin enables the body to use blood sugar (glucose). If there is a lack of insulin, or if it can't be used properly, the body will break down fat instead. The breakdown of fat releases harmful, acidic substances called ketones.The lack of insulin in your body leads to high blood glucose levels (hyperglycaemia). The combination of high ketone and blood sugar levels can cause a number of symptoms that can be very serious if the levels aren't corrected quickly. Symptoms of diabetic ketoacidosis The initial symptoms of diabetic ketoacidosis can develop quite suddenly. They will continue to get worse if not treated. Early symptoms In the early stages, the main signs of diabetic ketoacidosis include: passing large amounts of urine severe thirst weight loss feeling sick tiredness You may also develop other symptoms of dehydration, such as a dry mouth. If you have your own device or kit to measure your blood sugar and/or ketone levels, you may notice that the levels of both of these are higher than normal. Advanced symptoms Left untreated, more advanced symptoms can develop, including: rapid heartbeat (tachycardia) rapid breathing, where you breathe in more oxygen than your body actua Continue reading >>

Feline Diabetic Ketoacidosis

Feline Diabetic Ketoacidosis

Fall 2008 Ketoacidosis is a metabolic imbalance that is most commonly seen as a sequel to unmanaged or poorly regulated diabetes mellitus. It is caused by the breakdown of fat and protein in a compensatory effort for the need of more metabolic energy. The excessive breakdown of these stored reserves creates a toxic by-product in the form of ketones. As ketones build up in the blood stream, pH and electrolyte imbalances proceed. This condition is a potentially life-threatening emergency that requires immediate medical attention. Diabetes mellitus is a common endocrine disease in geriatric felines. It is caused by a dysfunction in the beta cells of the exocrine pancreas resulting in an absolute or relative deficiency of insulin. Insulin has been called the cells' gatekeeper. It attaches to the surface of cells and permits glucose, the cells' primary energy source, to enter from the blood. A lack of insulin results in a build up of glucose in the blood, physiologically causing a state of cellular starvation. In response to this condition the body begins to increase the mobilization of protein and fat storage. Fatty acids are released from adipose tissue, which are then oxidized by the liver. Normally, these fatty acids are formed into triglycerides. However, without insulin, these fatty acids are converted into ketone bodies, which cannot be utilized by the body. Together with the increased production and decreased utilization an abnormally high concentration of ketone bodies develop. These fixed acids are buffered by bicarbonate; however, the excessive amounts overwhelm and deplete the bicarbonate leading to an increase in arterial hydrogen ion concentration and a decrease in serum bicarbonate. This increase in hydrogen ions lowers the body's pH, leading to a metabolic ac Continue reading >>

Is Ketosis Dangerous? No, Because Ketosis Is Not Ketoacidosis.

Is Ketosis Dangerous? No, Because Ketosis Is Not Ketoacidosis.

At this point, I consider myself pretty immune to what internet trolls say to me. I have a pretty tough skin, usually laugh off nonsensical comments, and carry on with my day. This last time was different. When checking the social media account for my ketosis supplement company, Perfect Keto, I noticed a rather ridiculous comment. To the best of my memory, the comment said something like this: “How dare you promote ketosis?! I HATE KETOSIS! My daughter is a diabetic and had to be brought to hospital the other day because she was in ketoacidosis! Shame on you and everyone like who you recommends a dangerous diet that kills people! You are killing people! AGHHH!” Not only is this comment wildly misinformed and ignorant, I think comments like this are more dangerous than the promoting the ketogenic diet. When people make comments like this, they use the same scare tactics and lack of facts that have recently overtaken our political system to influence people in not using very beneficial tools to their advantage. Sometimes you just have to use your brain. The unfortunate truth is that this lady isn’t the only delusional and misinformed one instilling fear into people who are trying to gain benefit from their nutritional choices. Plenty of mainstream doctors also think the ketogenic diet is life threatening. I’ve recommended the ketogenic diet to many of my patients trying to fix weight and metabolic issues they haven’t been able to correct for years. One of them mentioned this change to their primary care physician, who was reviewing the statins and several other medications they have this patient on, who reacted with disbelief. Ketosis! How could I recommend such a life threatening intervention?! They were told not to see such a quack like myself any more before Continue reading >>

Diabetic Ketoacidosis With Two Life Threatening Infections: Mucormycosis, And Bilateral Emphysematous Pyelonepritis, Preciptating Erythema Nodosum Leprosum As The Initial Presentation Of Diabetes

Diabetic Ketoacidosis With Two Life Threatening Infections: Mucormycosis, And Bilateral Emphysematous Pyelonepritis, Preciptating Erythema Nodosum Leprosum As The Initial Presentation Of Diabetes

Ahmed Daoud1*, Amira Elbendary2,3, Mohanad Elfishawi1, Mahmoud Rabea1, Mostafa Alfishawy1,4, Sholkamy Amany MD and Wasfy Ayda MD 1Internal Medicine department – Kasr Alainy Hospital, Cairo University, Egypt 2Dermatology Department, Kasr Alainy Hospital, Cairo University, Egypt 3Ackerman Academy of Dermatopathology, New York, New York, USA 4Ichan School of Medicine, Mount Sinai/ Queens General Hospital, New York, USA Corresponding Author : Ahmed Daoud, MD 2250 Holly Hall street Apartment 126, Houston , Tx 77054 Tel: 8239297124 E-mail: [email protected] Received June 19, 2014; Accepted September 16, 2014; Published September 24, 2014 Citation: Daoud A, Elbendary A, Elfishawi M, Rabea M, Alfishawy M, et al. (2014) Diabetic Ketoacidosis with Two Life Threatening Infections: Mucormycosis, and Bilateral Emphysematous Pyelonepritis, Preciptating Erythema Nodosum Leprosum as the Initial Presentation of Diabetes. J Diabetes Metab 5:433 doi:10.4172/2155-6156.1000433 Copyright: © 2014 Daoud A, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Visit for more related articles at Journal of Diabetes & Metabolism Abstract Emphysematous pyelonephritis is an acute necrotizing renal and perirenal infection, caused by gas forming organism. Mucormycosis is an opportunistic aggressive fungal infection causing tissue thrombosis and necrosis. Erythema nodosum leprosum reaction is an inflammatory reaction occurring in borderline and lepromatous leprosy before, during or after multidrug treatment, where immune complexes deposit in various organs resulting in considerable damage to the organs that Continue reading >>

Diabetic Ketoacidosis (dka)

Diabetic Ketoacidosis (dka)

Diabetic ketoacidosis (DKA) is life threatening. DKA develops when there is a serious lack of insulin in the body. This may occur in several situations: at the time of diagnosis. About 10 to 25 children out of 100 with newly diagnosed diabetes end up in the emergency room with DKA. with a failure to take any or enough insulin with a failure to take enough extra insulin to cover the high sugar and ketone production caused by infection or other illness When there is not enough insulin available, blood sugar levels rise and excess sugar spills into the urine. Then the body starts breaking down fat as an alternative supply of energy. The ketones produced by fat breakdown are acidic, causing ketoacidosis. As the condition worsens, and more and more water is lost in the urine and through vomiting, the child becomes increasingly dehydrated. DKA can be avoided by careful attention to all aspects of the diabetes treatment plan. DKA usually develops over hours or days. high blood sugar levels and ketones in the urine excessive thirst urinating much more often and in larger amounts sudden loss of weight complaints of stomach pains or nausea vomiting leg cramps a flushed appearance headache signs of dehydration: dry mouth and tongue, sore throat, dark circles under the eyes deep, heavy breathing fruity-smelling breath drowsiness leading in time to unconsciousness If a child exhibits any of these signs, the blood sugar level and ketones in the urine should be checked. Notify the doctor right away. DKA must be treated in a hospital. Preventing DKA (type 1) In the child with established diabetes DKA is totally preventable. As a parent, you need to make sure that your child or teen is getting the right amount of insulin at the right time. One of the main reasons for developing DKA is f Continue reading >>

Hyperglycemic Crisis: Regaining Control

Hyperglycemic Crisis: Regaining Control

CE credit is no longer available for this article. Expired July 2005 Originally posted April 2004 VERONICA CRUMP, RN, BSN VERONICA CRUMP is a nurse on the surgical unit of Morristown Memorial Hospital in Morristown, N.J. She's also a subacute care nurse in the hospital's rehabilitation division. KEY WORDS: hyperosmolar hyperglycemic syndrome (HHS), diabetic ketoacidosis (DKA), hepatic glucose production, proteolysis, hepatic gluconeogenesis, ketone bodies, metabolic acidosis, hyperkalemia, hypokalemia When a patient presents with markedly high blood glucose levels, the consequences can be fatal. Here's how to get your patient through the crisis. Edith Schafer, age 71, has just been admitted to your ICU with pneumonia, which she developed at home. She has a history of Type 2 diabetes. In addition to a temperature of 102° F (38.9° C), she has rapid, shallow breathing and dry, flushed skin. Her blood pressure is 96/70 mm Hg, and she's so lethargic that she's unable to keep her eyes open. Her lab results show a serum glucose level of 900 mg/dL. In addition to the pneumonia, Mrs. Schafer is suffering from hyperosmolar hyperglycemic syndrome (HHS). Severe hyperglycemia is a complication of both Type 1 and Type 2 diabetes. It can indicate HHS or diabetic ketoacidosis (DKA), another life-threatening condition. HHS tends to occur in patients with Type 2 diabetes, like Mrs. Schafer, while Type 1 diabetics are more likely to develop DKA. However, DKA can occur in Type 2 diabetes as well.1 HHS and DKA can be set off by infection, stress, missed medication, and other causes. In Mrs. Schafer's case, the trigger was pneumonia, a common cause of hyperglycemia in patients with diabetes. No matter what the cause, though, a case of HHS or DKA can turn deadly if not caught in time. The m Continue reading >>

Diabetic Ketoacidosis: Know The Signs And Symptoms Of This Life-threatening Situation!

Diabetic Ketoacidosis: Know The Signs And Symptoms Of This Life-threatening Situation!

If you take insulin to manage your diabetes, you could be at risk of diabetic ketoacidosis (DKA). DKA usually occurs in people with type 1 diabetes, but it has been known to happen in people with type 2 diabetes who take multiple injections per day of insulin and who have a pancreas that has essentially stopped working due to pancreatitis, cystic fibrosis or other conditions. DKA is a condition that is caused by blood glucose levels that are high for a sustained period of time. If DKA is not recognized and treated, it can lead to a coma or even death. This can happen fairly quickly, sometimes within the space of 24 hours. DKA results from a lack of sufficient insulin. Insulin is required to move glucose into the body’s cells. If there is not enough insulin to do this, the body will generate something called ketones, which are toxic, acidic chemicals that are produced when fat – instead of glucose – is burned for energy. Ketones can change the pH of the body, making it more acidic. Having a body that is too acidic can be fatal. These are the warning signs of DKA: • Extreme thirst and/or a dry mouth • Feeling tired • High blood sugar levels • Difficulty breathing, or shortness of breath • A “fruity” smell to your breath • Abdominal pain • Nausea and vomiting • Loss of consciousness and coma The best way to tell if you have DKA is to measure your blood sugar levels; in DKA, blood glucose levels are usually higher than 15 mmol/L. You can also check for the presence of ketones by using a blood ketone meter (for example, the FreeStyle Precision Neo™ Blood Glucose and Ketone Monitoring System) or urine ketone strips; however, urine testing may not be as accurate as checking blood ketone levels. DKA is triggered by a lack of adequate insulin, which c Continue reading >>

Diabetic Ketoacidosis (dka)

Diabetic Ketoacidosis (dka)

Diabetic ketoacidosis is an acute metabolic complication of diabetes characterized by hyperglycemia, hyperketonemia, and metabolic acidosis. Hyperglycemia causes an osmotic diuresis with significant fluid and electrolyte loss. DKA occurs mostly in type 1 diabetes mellitus (DM). It causes nausea, vomiting, and abdominal pain and can progress to cerebral edema, coma, and death. DKA is diagnosed by detection of hyperketonemia and anion gap metabolic acidosis in the presence of hyperglycemia. Treatment involves volume expansion, insulin replacement, and prevention of hypokalemia. Diabetic ketoacidosis (DKA) is most common among patients with type 1 diabetes mellitus and develops when insulin levels are insufficient to meet the body’s basic metabolic requirements. DKA is the first manifestation of type 1 DM in a minority of patients. Insulin deficiency can be absolute (eg, during lapses in the administration of exogenous insulin) or relative (eg, when usual insulin doses do not meet metabolic needs during physiologic stress). Common physiologic stresses that can trigger DKA include Some drugs implicated in causing DKA include DKA is less common in type 2 diabetes mellitus, but it may occur in situations of unusual physiologic stress. Ketosis-prone type 2 diabetes is a variant of type 2 diabetes, which is sometimes seen in obese individuals, often of African (including African-American or Afro-Caribbean) origin. People with ketosis-prone diabetes (also referred to as Flatbush diabetes) can have significant impairment of beta cell function with hyperglycemia, and are therefore more likely to develop DKA in the setting of significant hyperglycemia. SGLT-2 inhibitors have been implicated in causing DKA in both type 1 and type 2 DM. Continue reading >>

My Encounter With Diabetic Ketoacidosis

My Encounter With Diabetic Ketoacidosis

The Truth Behind My Encounter With Diabetic Ketoacidosis: A day like any other, can turn into a day you’ll never forget) With diabetes comes the good and the bad. When it’s good, it can be REALLY good. But when it’s bad…it can be life-threatening. I’ve certainly had my share of bad days. Trying to battle the high and the lows, and trying to stay as close to normal without losing my sanity. With having diabetes I’ve experienced many symptoms. But one day came symptoms like no other… chills – nausea – vomiting – back pain – weakness – blurred vision … and lots of ketones I had DKA (Diabetic Ketoacidosis) This was years ago, after a night of drinking with friends. Wanting to live a free, independent young adult life. Knowing, yet not knowing how destructive being the slightest bit careless could affect my diabetes. I just felt terrible. To the point where I questioned where to take insulin or not. I thought to myself … Well I don’t really plan on eating today, and I don’t want to worry about dropping “low”. I thought I was saving myself from having to fix my blood sugar. So I missed my morning dose… (Boy, was that a mistake – NEVER – would I do this again) I didn’t know at the time that insulin is needed (with or without food) Even on sick days! Without insulin in my body, my body couldn’t receive the energy to function properly. I kept close eyes on my blood sugar for a few hours that day, which was only in the mid 200’s. I thought that due to the fact I wasn’t eating, my blood sugar would come down eventually anyways. But the symptoms progressed. I couldn’t keep anything down … not even water. To be honest, DKA never came to mind. I’ve always taken my insulin. The only other time was when I was diagnosed, and was mo Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

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

Question: Ketoacidosis Is A Potentially Life-threatening Condition That Can Occur When There Is Inadequate ...

Question: Ketoacidosis Is A Potentially Life-threatening Condition That Can Occur When There Is Inadequate ...

Ketoacidosis is a potentially life-threatening condition that can occur when there is inadequate cellular glucose uptake, such as in uncontrolled diabetes. Order the steps that would lead to the development of ketoacidosis. Continue reading >>

Diabetic Ketoacidosis Simulator: A New Learning Tool For A Life Threatening Condition

Diabetic Ketoacidosis Simulator: A New Learning Tool For A Life Threatening Condition

Isabel Huguet, J Joaquín Alfaro, César Gonzalvo, Cristina Lamas, Antonio Hernández & Francisco Botella Introduction: Diabetic ketoacidosis (DKA) remains a life threatening complication in type 1 diabetes. Appropiate initial management is crucial in the evolution of this complex condition, and mistakes in the treatment are not uncommon. Medical simulation technology is a powerful tool for training physicians but papers dealing with DKA simulators are scarce. We introduce a new simulator designed in our institution aimed to junior doctors’ training in DKA treatment whose implementation permits physicians to solve more case than what they would manage in the Emergency Room. Material and methods: A software was developed by using mathematic algorithms based in previously published and empiric formulas to simulate the evolution of DKA both under appropriate and inappropriate management. Results: The DKA simulator shows several cases to the trainee. Every case is compound by a clinical history and some variables which define the basal situation of the simulated patient: sex, age, weight, glucose, 3-β-OH-butyrate, sodium, potassium, serum creatinine, renal function, grade of dehydration, insulin sensitivity and ability to hyperventilation. The last four parameters are not shown to the trainee, but used by the simulator. The trainee has to indicate the initial management, ask for biochemical test when necessary, and make successive changes in the treatment (iv insulin rate, type and rate of fluidotherapy and potassium administered) until DKA resolution is reached or, eventually, the death of the patient happens if the management has not been correct. By using mathematical algorithms, and according to the characteristics and the duration of the treatment, our simulator pro Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Introduction Diabetic ketoacidosis (DKA) is a dangerous complication of diabetes caused by a lack of insulin in the body. Diabetic ketoacidosis occurs when the body is unable to use blood sugar (glucose) because there isn't enough insulin. Instead, it breaks down fat as an alternative source of fuel. This causes a build-up of a by-product called ketones. Most cases of diabetic ketoacidosis occur in people with type 1 diabetes, although it can also be a complication of type 2 diabetes. Symptoms of diabetic ketoacidosis include: passing large amounts of urine feeling very thirsty vomiting abdominal pain Seek immediate medical assistance if you have any of these symptoms and your blood sugar levels are high. Read more about the symptoms of diabetic ketoacidosis. Who is affected by diabetic ketoacidosis? Diabetic ketoacidosis is a relatively common complication in people with diabetes, particularly children and younger adults who have type 1 diabetes. Younger children under four years of age are thought to be most at risk. In about 1 in 4 cases, diabetic ketoacidosis develops in people who were previously unaware they had type 1 diabetes. Diabetic ketoacidosis accounts for around half of all diabetes-related hospital admissions in people with type 1 diabetes. Diabetic ketoacidosis triggers These include: infections and other illnesses not keeping up with recommended insulin injections Read more about potential causes of diabetic ketoacidosis. Diagnosing diabetic ketoacidosis This is a relatively straightforward process. Blood tests can be used to check your glucose levels and any chemical imbalances, such as low levels of potassium. Urine tests can be used to estimate the number of ketones in your body. Blood and urine tests can also be used to check for an underlying infec Continue reading >>

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