Ketoacidosis In A Non-diabetic Woman Who Was Fasting During Lactation
Abstract Ketoacidosis is a potential complication of type 1 diabetes. Severe ketoacidosis with a blood pH below 7.0 is only rarely seen in other diseases. Three weeks after delivery, a young woman was admitted because of tachypnoe and tachycardia. Blood gas analysis showed a severe metabolic acidosis with a high anion gap. Further workup revealed the presence of ketone bodies in the urine with normal blood glucose and no history of diabetes. The patient reported that she had not eaten for days because of abdominal pain. After initial treatment in the ICU and immediate re-feeding, the patient’s condition rapidly improved. While under normal circumstances fasting causes at most only mild acidosis, it can be dangerous during lactation. Prolonged fasting in combination with different forms of stress puts breast feeding women at risk for starvation ketoacidosis and should therefore be avoided. Background Severe acidosis is a potentially life-threatening condition. In case of metabolic acidosis, determination of the serum anion gap helps to narrow down the differential diagnosis. An increased anion gap indicates the presence of an unusual amount of an acid that is most commonly found in ketoacidosis, lactic acidosis, renal insufficiency, and intoxications while other causes are rare. Ketoacidosis is a potential complication of type 1 diabetes while severe ketoacidosis with a blood pH below 7.0 is only rarely seen in other diseases. In diabetic ketoacidosis, glucose is not properly taken up into tissue due to an absolute insulin deficiency that is mainly found in type 1 diabetes. In parallel, glucagon release is not suppressed leading to hyperglucagonemia. Subsequently the body activates stress hormones, which worsen hyperglycemia by promoting gluconeogenesis (and also ketog Continue reading >>
Ketosis Vs Ketoacidosis: Is Keto Healthy?
Because the two terms look and sound similar, many people often confuse ketoacidosis with ketosis. These conditions have very different meanings and effects on the body. One is a highly dangerous condition while the other has been shown to help you lose weight, prevent disease, and improve cognitive function. Here’s what you need to know about the difference between ketoacidosis and ketosis. What is Ketoacidosis? Ketoacidosis or diabetic ketoacidosis (DKA) is a life-threatening condition that results as a complication of type one diabetes. It occurs when there are dangerously high levels of ketones and blood sugar present at the same time. Ketones are compounds that are produced when the body uses fat instead of sugar as fuel. The combination of having too many ketones and too much glucose present in your blood makes it become highly acidic. This can result in damage to the normal functioning of your kidney and liver. Ketoacidosis can develop in the body within 24 hours and requires immediate care. The condition commonly affects people with type one diabetes who do not produce enough or any insulin. People with type two diabetes can also develop the condition. Ketoacidosis can be triggered by improper diet, infection or illness, and not taking proper doses of insulin (in diabetic patients). Symptoms of ketoacidosis include nausea, vomiting, and abdominal pain. Other symptoms may include a fruity odor on the person’s breath. A person’s breathing may also become rapid and shallow (1). Ketoacidosis is the leading cause of death in people with diabetes under the age of 24. Approximately 36 percent of the people who develop ketoacidosis are under the age of 30 while 27 percent are between 30 and 50, 23 percent are between 51 and 70, and 14 percent are over 70. Studies Continue reading >>
Cardiovascular Complications Of Ketoacidosis
US Pharm. 2016;41(2):39-42. ABSTRACT: Ketoacidosis is a serious medical emergency requiring hospitalization. It is most commonly associated with diabetes and alcoholism, but each type is treated differently. Some treatments for ketoacidosis, such as insulin and potassium, are considered high-alert medications, and others could result in electrolyte imbalances. Several cardiovascular complications are associated with ketoacidosis as a result of electrolyte imbalances, including arrhythmias, ECG changes, ventricular tachycardia, and cardiac arrest, which can be prevented with appropriate initial treatment. Acute myocardial infarction can predispose patients with diabetes to ketoacidosis and worsen their cardiovascular outcomes. Cardiopulmonary complications such as pulmonary edema and respiratory failure have also been seen with ketoacidosis. Overall, the mortality rate of ketoacidosis is low with proper and urgent medical treatment. Hospital pharmacists can help ensure standardization and improve the safety of pharmacotherapy for ketoacidosis. In the outpatient setting, pharmacists can educate patients on prevention of ketoacidosis and when to seek medical attention. Metabolic acidosis occurs as a result of increased endogenous acid production, a decrease in bicarbonate, or a buildup of endogenous acids.1 Ketoacidosis is a metabolic disorder in which regulation of ketones is disrupted, leading to excess secretion, accumulation, and ultimately a decrease in the blood pH.2 Acidosis is defined by a serum pH <7.35, while a pH <6.8 is considered incompatible with life.1,3 Ketone formation occurs by breakdown of fatty acids. Insulin inhibits beta-oxidation of fatty acids; thus, low levels of insulin accelerate ketone formation, which can be seen in patients with diabetes. Extr Continue reading >>
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 >>
Ketoacidosis Vs. Ketosis: What's The Difference?
You may have heard the term "keto" or ketogenic floating around. So what exactly is ketoacidosis, ketosis and ketones? Here, we break it down for you. "Keto" is derived from the word ketone, a specific class of organic compounds in your body that are produced when your body burns fat instead of carbohydrates. Your body prefers to burn carbohydrates (glucose) for energy. However, if there is not enough glucose to burn, you will start burning fat instead. This process is called ketosis. Ketones circulate in the bloodstream and are used by tissues and muscles for fuel. You will excrete any ketones not used for energy in your urine. Don't Miss: Healthy Low-Carb Recipes Ketosis vs. Ketoacidosis "Ketosis is simply the presence of ketones in the blood," says Staci Freeworth, R.D., C.D.E., professor of nutrition at Bowling Green State University. "This can be caused by periods of energy imbalance, a change in diet, pregnancy or overconsumption of alcohol." Ketosis is a normal response in the body when a healthy person with a balanced diet starts fasting or severely restricting calories or carbohydrates (e.g., the super low-carb ketogenic diet). Ketosis happens when the body senses a state of starvation. Ketoacidosis is when blood levels of ketones are so high that your blood becomes too acidic. "Ketoacidosis is short for diabetic ketoacidosis and occurs in diabetics who do not make insulin or stop taking their prescribed insulin, typically people with type 1 diabetes," Freeworth says. It can lead to a diabetic coma or even death, according to the American Diabetes Association. Insulin helps transport your blood glucose (or blood sugar) to your cells and tissues. People with type 1 diabetes, and some people with type 2 diabetes, have to inject insulin because their bodies do not Continue reading >>
DKA is usually signaled by high blood sugar levels. The important fact to remember is that without enough insulin, the body cannot burn glucose properly and fat comes out of fat cells. Diabetic Ketoacidosis (DKA) – a condition brought on by inadequate insulin – is a life-threatening emergency usually affecting people with type 1 diabetes. Although less common, it also can happen when you have type 2 diabetes. DKA is usually, but not always, signaled by high blood sugar levels. The important fact to remember is that without enough insulin, the body cannot burn glucose properly and fat comes out of fat cells. As a consequence the excess fat goes to the liver and glucose builds up in the bloodstream. The liver makes ketoacids (also known as ketones) out of the fat. Before long, the body is literally poisoning itself with excess glucose and ketoacids. What causes DKA? A lack of insulin usually due to: Unknown or newly diagnosed cases of type 1 diabetes Missed or inadequate doses of insulin, or spoiled insulin Infection Steroid medications An extremely stressful medical condition DKA is rare in type 2 diabetes – but can develop if someone with type 2 diabetes gets another serious medical condition. Examples of medical conditions associated with DKA in type 2 diabetes are severe infections, acute pancreatitis (inflammation of the insulin producing organ, the pancreas), and treatment with steroids. Symptoms of DKA include: Nausea, vomiting Stomach pain Fruity breath – the smell of ketoacids Frequent urination Excessive thirst Weakness, fatigue Speech problems, confusion or unconsciousness Heavy, deep breathing How do you know if you have DKA? Check your blood or urine for ketones. And if the test is positive, you will need immediate medical care. Treatment includes agg Continue reading >>
Euglycemic Diabetic Ketoacidosis: A Diagnostic And Therapeutic Dilemma
Prashanth Rawla1, Anantha R Vellipuram2, Sathyajit S Bandaru3 and Jeffrey Pradeep Raj4 Department of Internal Medicine, Memorial Hospital of Martinsville and Henry County, Martinsville, Virginia, USA  Texas Tech University Health Sciences Center, El Paso, Texas, USA  Senior Research Associate, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA  Department of Pharmacology, St John’s Medical College, Bangalore, India Summary Euglycemic diabetic ketoacidosis (EDKA) is a clinical triad comprising increased anion gap metabolic acidosis, ketonemia or ketonuria and normal blood glucose levels <200 mg/dL. This condition is a diagnostic challenge as euglycemia masquerades the underlying diabetic ketoacidosis. Thus, a high clinical suspicion is warranted, and other diagnosis ruled out. Here, we present two patients on regular insulin treatment who were admitted with a diagnosis of EDKA. The first patient had insulin pump failure and the second patient had urinary tract infection and nausea, thereby resulting in starvation. Both of them were aggressively treated with intravenous fluids and insulin drip as per the protocol for the blood glucose levels till the anion gap normalized, and the metabolic acidosis reversed. This case series summarizes, in brief, the etiology, pathophysiology and treatment of EDKA. Euglycemic diabetic ketoacidosis is rare. Consider ketosis in patients with DKA even if their serum glucose levels are normal. High clinical suspicion is required to diagnose EDKA as normal blood sugar levels masquerade the underlying DKA and cause a diagnostic and therapeutic dilemma. Blood pH and blood or urine ketones should be checked in ill patients with diabetes regardless of blood glucose levels. Background Diabetic ket Continue reading >>
Diabetic ketoacidosis (DKA) is a serious, life-threatening complication of diabetes mellitus. DKA is characterized by the triad of hyperglycemia, anion gap metabolic acidosis, and ketonemia. It is part of a spectrum of hyperglycemia on which lies hyperosmolar hyperglycemic state (HHS). Though the two are distinct entities, they do share some commonalities. DKA is caused by the reduced effect of insulin, either due to deficit or reduction of levels, with concomitant elevation of counter regulatory hormones (glucagon, catecholamines, cortisol, and growth hormones), generally due to a precipitating stress. Increased gluconeogenesis, glycogenolysis, and decreased glucose uptake by cells leads to hyperglycemia, while insulin deficiency leads to mobilization and oxidization of fatty acids leading to ketogenesis. Although DKA may be the initial manifestation of diabetes, it is typically precipitated by other factors. It is critical for a clinician to identify and treat these factors. Infection can be found in 40-50% of patients with hyperglycemic crisis, with urinary tract infection and pneumonia accounting for the majority of cases. DKA is a life-threatening medical emergency with a mortality rate just under 5% in individuals under 40 years of age, but with a more serious prognosis in the elderly, who have mortality rates over 20%. Deaths may also occur as a result of hypokalemia induced arrhythmias and cerebral edema (more common in children). II. Diagnostic confirmation: are you sure your patient has diabetic ketoacidosis? Although the diagnosis of DKA can be suspected on clinical grounds, confirmation is based on laboratory tests including potential hydrogen (pH) level, urinalysis, and basic metabolic profile. summarizes the biochemical criteria for the diagnosis and asse Continue reading >>
What Is Diabetic Ketoacidosis?
Diabetic ketoacidosis is a buildup of acids in the blood. It is a life-threatening complication of diabetes resulting from not having enough insulin. It may happen with type 1 diabetes. (It rarely happens with type 2 diabetes.) It’s an emergency that must be treated right away. If ketoacidosis is not treated right away, it can cause coma or death. What is the cause? Diabetic ketoacidosis happens when the body does not have enough insulin. Without insulin, sugars in the blood cannot move out of the blood and into the body’s cells, so the cells burn fats instead of sugar for energy. The burning of fats makes byproducts called ketones. The ketones build up to poisonous and dangerous levels in the blood. Usually the blood sugar is also very high. Ketoacidosis can happen if you skip doses of insulin. Or it may happen if there is a change in your life, such as: Infection Injury Heart attack Surgery Pregnancy Other types of physical or emotional stress If you are using an insulin pump, it may happen if you stop getting insulin because there is a kink in the tube or the tube comes out. Sometimes you may not know you have diabetes until ketoacidosis occurs. When the pancreas stops making insulin, it happens over a short period of time. In just a few days your blood sugar can get very high and ketones can build up to a high level very fast. It may happen so fast that ketoacidosis symptoms are the first symptoms of diabetes that you have. What are the symptoms? Symptoms of ketoacidosis may include: Shortness of breath Fruity smelling breath Very dry mouth Nausea and vomiting Symptoms of high blood sugar may include: Blurry vision Dry mouth Feeling very thirsty and drinking a lot Urinating a lot Tiredness Several hours to a couple of days after symptoms start, ketoacidosis may Continue reading >>
How To Identify And Manage Diabetic Ketoacidosis In Adults
By Natasha Jacques, BSc, MRPharmS, and Sally James, MSc, MRPharmS In short Diabetic ketoacidosis (DKA) is a condition in which a lack of insulin leads to hyperglycaemia, ketosis and metabolic acidosis. The symptoms of DKA include thirst, polyuria, confusion, fatigue and nausea. Treatment of DKA centres around the administration of intravenous fluids (including potassium) and infusions of soluble insulin. Natasha Jacques is principal pharmacist for diabetes at Heart of England NHS Foundation Trust and Sally James is divisional pharmacist for medicine at Royal Liverpool and Broadgreen University Hospital NHS Trust. Both authors are committee members of the United Kingdom Clinical Pharmacy Association diabetes group. Call for Practice tools Useful clinical skills are described in this Clinical Pharmacist series. Comments on this or other articles are welcomed in the form of personal feedback to the editor or correspondence to Clinical Pharmacist. Pharmacists who have ideas for the series or wish to write an article are invited to contact the editor. Email: [email protected] Telephone: +44 (0)20 7572 2425 Continue reading >>
Home > Our Services > Health Info Library > Helping Hands > Diabetes: Ketoacidosis (dka)
Diabetic Ketoacidosis (KEY toe as i DOE sis), also known as DKA, is a serious complication of diabetes. When the cells in the body cannot use glucose for energy, there is a buildup of acids called “ketones” in the blood. For the cells to use glucose for energy both glucose and insulin need to be in the blood. Insulin acts like a key to unlock the cell door. It allows glucose in to be used for energy. When cells do not have glucose to use for energy: The body starts to use fat for energy. Ketones are made when fat is used for energy. Ketones are present in the blood and in the urine. Ketones cause the blood to become more acidic. If untreated, this leads to DKA and life-threatening problems. Cause Not enough insulin: Missing doses of insulin Infection, illness or injury (which causes the body to need more insulin) Insulin doses too small If using insulin pump, interruption in delivery of insulin Signs of DKA and When to Test for Ketones You may or may not feel any different when you begin to have ketones. The only way to know is by checking the urine or blood for the presence of ketones. Check for ketones if blood glucose is higher than 300 mg/dl. Check for ketones when ill (fever, flu or vomiting) even if blood glucose is not higher than 300 mg/dl. Warning Signs of DKA Fast breathing Fruity smell to the breath Hard to wake up Feeling sick to the stomach (nausea), belly pain, or vomiting How to Check Urine for Ketones Step 1: Check the expiration date on the bottle. Note that ketone strips expire 6 months after opening bottle. Step 2: Collect urine in a cup. Dip the ketone strip into the cup. Remove it from the urine. Step 3: Wait 15 seconds. Step 4: Match the color on the ketone strip to the colors on the bottle. You can also check blood for ketones. Your health car Continue reading >>
Patient professional reference Professional Reference articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use. You may find one of our health articles more useful. Diabetic ketoacidosis (DKA) is the leading cause of mortality in childhood diabetes.The primary cause of DKA is absolute or relative insulin deficiency: Absolute - eg, previously undiagnosed type 1 diabetes mellitus or a patient with known type 1 diabetes who does not take their insulin. Relative - stress causes a rise in counter-regulatory hormones with relative insulin deficiency. DKA can be fatal The usual causes of death are: Cerebral oedema - associated with 25% mortality (see 'Cerebral odedema', below). Hypokalaemia - which is preventable with good monitoring. Aspiration pneumonia - thus, use of a nasogastric tube in the semi-conscious or unconscious is advised. Deficiency of insulin. Rise in counter-regulatory hormones, including glucagon, cortisol, growth hormone, and catecholamines. Thus, inappropriate gluconeogenesis and liver glycogenolysis occur compounding the hyperglycaemia, which causes hyperosmolarity and ensuing polyuria, dehydration and loss of electrolytes. Accelerated catabolism from lipolysis of adipose tissue leads to increased free fatty acid circulation, which on hepatic oxidation produces the ketone bodies (acetoacetic acid and beta-hydroxybutyric acid) that cause the metabolic acidosis. A vicious circle is usually set up as vomiting usually occurs compounding the stress and dehydration; the cycle can only be broken by providing insulin and fluids; otherwise, severe acidosis occurs and can be fatal. Biochemical criteria The biochemical criteria required for a diagnosis of DKA to be made are Continue reading >>
Diabetic ketoacidosis (DKA) happens when your blood sugar is high and your insulin level is low. This imbalance in the body causes a build-up of ketones. Ketones are toxic. If DKA isn’t treated, it can lead to diabetic coma and even death. DKA mainly affects people who have type 1 diabetes. But it can also happen with other types of diabetes, including type 2 diabetes and gestational diabetes (during pregnancy). DKA is a very serious condition. If you have diabetes and think you may have DKA, contact your doctor or get to a hospital right away. The first symptoms to appear are usually: frequent urination. The next stage of DKA symptoms include: vomiting (usually more than once) confusion or trouble concentrating a fruity odor on the breath. The main cause of DKA is not enough insulin. A lack of insulin means sugar can’t get into your cells. Your cells need sugar for energy. This causes your body’s glucose levels to rise. To get energy, the body starts to burn fat. This process causes ketones to build up. Ketones can poison the body. High blood glucose levels can also cause you to urinate often. This leads to a lack of fluids in the body (dehydration). DKA can be caused by missing an insulin dose, eating poorly, or feeling stressed. An infection or other illness (such as pneumonia or a urinary tract infection) can also lead to DKA. If you have signs of infection (fever, cough, or sore throat), contact your doctor. You will want to make sure you are getting the right treatment. For some people, DKA may be the first sign that they have diabetes. When you are sick, you need to watch your blood sugar level very closely so that it doesn’t get too high or too low. Ask your doctor what your critical blood sugar level is. Most patients should watch their glucose levels c Continue reading >>
Ketoacidosis During A Low-carbohydrate Diet
To the Editor: It is believed that low-carbohydrate diets work best in reducing weight when producing ketosis.1 We report on a 51-year-old white woman who does not have diabetes but had ketoacidosis while consuming a “no-carbohydrate” diet. There was no family history of diabetes, and she was not currently taking any medications. While adhering to a regimen of carbohydrate restriction, she reached a stable weight of 59.1 kg, a decrease from 72.7 kg. After several months of stable weight, she was admitted to the hospital four times with vomiting but without abdominal pain. On each occasion, she reported no alcohol use. Her body-mass index (the weight in kilograms divided by the square of the height in meters) was 26.7 before the weight loss and 21.7 afterward. Laboratory evaluation showed anion-gap acidosis, ketonuria, and elevated plasma glucose concentrations on three of the four occasions (Table 1). She had normal concentrations of plasma lactate and glycosylated hemoglobin. Screening for drugs, including ethyl alcohol and ethylene glycol, was negative. Abdominal ultrasonography showed hepatic steatosis. On each occasion, the patient recovered after administration of intravenous fluids and insulin, was prescribed insulin injections on discharge, and gradually reduced the use of insulin and then discontinued it while remaining euglycemic for six months or more between episodes. Testing for antibodies against glutamic acid decarboxylase and antinuclear antibodies was negative. Values on lipid studies were as follows: serum triglycerides, 102 mg per deciliter; high-density lipoprotein (HDL) cholesterol, 50 mg per deciliter; and calculated low-density lipoprotein (LDL) cholesterol, 189 mg per deciliter. The patient strictly adhered to a low-carbohydrate diet for four Continue reading >>
Ketones in the urine, as detected by urine testing stix or a blood ketone testing meter, may indicate the beginning of diabetic ketoacidosis (DKA), a dangerous and often quickly fatal condition caused by low insulin levels combined with certain other systemic stresses. DKA can be fixed if caught quickly. Diabetics of all species therefore need to be checked for ketones with urine testing stix, available at any pharmacy, whenever insulin level may be too low, and any of the following signs or triggers are present: Ketone Monitoring Needed: Little or no insulin in last 12 hours High blood sugar over 16 mmol/L or 300 mg/dL (though with low insulin, lower as well...) Dehydration (skin doesn't jump back after pulling a bit gums are tacky or dry) Not eating for over 12 hours due to Inappetance or Fasting Vomiting Lethargy Infection or illness High stress levels Breath smells like acetone (nail-polish remover) or fruit. Note that the triggers and signs are somewhat interchangeable because ketoacidosis is, once begun, a set of vicious circles which will make itself worse. So dehydration, hyperglycemia, fasting, and presence of ketones are not only signs, they're also sometimes triggers. In a diabetic, any urinary ketones above trace, or any increase in urinary ketone level, or trace urinary ketones plus some of the symptoms above, are cause to call an emergency vet immediately, at any hour of the day. Possible False Urine Ketone Test Results Drugs and Supplements Valproic Acid (brand names) Depakene, Depakote, Divalproex Sodium Positive. Common use: Treatment of epilepsy. Cefixime/Suprax Positive with nitroprusside-based urine testing. Common use: Antibiotic. Levadopa Metabolites Positive with high concentrations. Tricyclic Ring Compounds Positive. Commo Continue reading >>