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Keto Acidosis

Diabetes With Ketone Bodies In Dogs

Diabetes With Ketone Bodies In Dogs

Studies show that female dogs (particularly non-spayed) are more prone to DKA, as are older canines. Diabetic ketoacidosis is best classified through the presence of ketones that exist in the liver, which are directly correlated to the lack of insulin being produced in the body. This is a very serious complication, requiring immediate veterinary intervention. Although a number of dogs can be affected mildly, the majority are very ill. Some dogs will not recover despite treatment, and concurrent disease has been documented in 70% of canines diagnosed with DKA. Diabetes with ketone bodies is also described in veterinary terms as diabetic ketoacidosis or DKA. It is a severe complication of diabetes mellitus. Excess ketone bodies result in acidosis and electrolyte abnormalities, which can lead to a crisis situation for your dog. If left in an untreated state, this condition can and will be fatal. Some dogs who are suffering from diabetic ketoacidosis may present as systemically well. Others will show severe illness. Symptoms may be seen as listed below: Change in appetite (either increase or decrease) Increased thirst Frequent urination Vomiting Abdominal pain Mental dullness Coughing Fatigue or weakness Weight loss Sometimes sweet smelling breath is evident Slow, deep respiration. There may also be other symptoms present that accompany diseases that can trigger DKA, such as hypothyroidism or Cushing’s disease. While some dogs may live fairly normal lives with this condition before it is diagnosed, most canines who become sick will do so within a week of the start of the illness. There are four influences that can bring on DKA: Fasting Insulin deficiency as a result of unknown and untreated diabetes, or insulin deficiency due to an underlying disease that in turn exacerba Continue reading >>

Ketoacidosis In A Non-diabetic Adult With Chronic Etoh Consumption

Ketoacidosis In A Non-diabetic Adult With Chronic Etoh Consumption

Go to: Case Report A 67-year-old Caucasian woman presented to our emergency room with alteration of mental status. She was found on the floor of her apartment, confused without apparent head trauma and no documented loss of consciousness. She admitted chronic alcohol consumption. Her main medical conditions included chronic obstructive lung disease, hypertension, hypothyroidism, major depressive disorder and anxiety. On presentation, she was difficult to arouse, disoriented and showed an important decrease in attention span. She was mildly tachycardic, normotensive, and tachypneic. Her temperature was 37.5 °C rectally. Physical examination was unremarkable. Initial arterial blood gas showed a high anion gap metabolic acidosis (pH 7.23, pCO2 16 mm Hg, HCO3 7 mmol/L, anion gap 45, and lactate 1.0 mmol/L). Her serum glucose at presentation was 12.9 mmol/L and her B-hydroxybutyrate was 7.88 mmol/L. Ketones were present in the urine while glucose was not. Toxicological serum studies did not reveal any acute intoxication. Mild elevation in her liver function tests was noted initially (AST 92 U/L, ALT 56 U/L, and total bilirubin 24 μmol/L) which normalized few days later. Her pancreatic function tests remained benign. Electrolytes imbalances at presentation included hyponatremia (132 mmol/L), hypokalemia (3.0 mmol/L), hypochloremia (84 mmol/L) and hypophosphatemia (0.3 mmol/L). The patient’s presentation was suggestive of a ketoacidosis, while it was still unclear if she was an undiagnosed diabetic. Initial management included insulin and dextrose 10% perfusion (with fluid repletion, thiamine, and electrolytes replacement). Further laboratory investigation revealed an HbA1c of 5.13% and rapid normalization of glycemia, excluding a diagnosis of late-onset type 1 diabetes, i Continue reading >>

Diabetes With Ketone Bodies In Dogs

Diabetes With Ketone Bodies In Dogs

Diabetes Mellitus with Ketoacidosis in Dogs Diabetes is a medical condition in which the body cannot absorb sufficient glucose, thus causing a rise the blood sugar levels. The term “ketoacidosis,” meanwhile, refers to a condition in which levels of acid abnormally increased in the blood due to presence of “ketone bodies”. In diabetes with ketoacidosis, ketoacidosis immediately follows diabetes. It should be considered a dire emergency, one in which immediate treatment is required to save the life of the animal. This condition typically affects older dogs as well as females. In addition, miniature poodles and dachshunds are predisposed to diabetes with ketoacidosis. Symptoms and Types Weakness Lethargy Depression Lack of appetite (anorexia) Muscle wasting Rough hair coat Dehydration Dandruff Sweet breath odor Causes Although the ketoacidosis is ultimately brought on by the dog's insulin dependency due to diabetes mellitus, underlying factors include stress, surgery, and infections of the skin, respiratory, and urinary tract systems. Concurrent diseases such as heart failure, kidney failure, asthma, cancer may also lead to this type of condition. Diagnosis You will need to give a thorough history of your dog’s health, including the onset and nature of the symptoms, to your veterinarian. He or she will then perform a complete physical examination, as well as a biochemistry profile and complete blood count (CBC). The most consistent finding in patients with diabetes is higher than normal levels of glucose in the blood. If infection is present, white blood cell count will also high. Other findings may include: high liver enzymes, high blood cholesterol levels, accumulation in the blood of nitrogenous waste products (urea) that are usually excreted in the urine (azo Continue reading >>

Section 5: Risk Of Diabetic Ketoacidosis

Section 5: Risk Of Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a serious complication of diabetes The risk of DKA is greater in insulin pump therapy compared to MDI More precautions and diligence are required to prevent DKA in pump therapy Diabetic ketoacidosis (DKA) is a complication of diabetes that can result in death. DKA occurs when there is not enough insulin in the body. Too little insulin leads to a build up of acids, called ketones, in the blood. Anyone with type 1 diabetes can develop DKA, particularly when ill. However, those on pumps are at much greater risk. Remember that the insulin pump does not use any intermediate or long-acting insulin. With only rapid-acting insulin, people on pumps can develop severely high blood sugars or DKA in as little as 2-4 hours if their infusion is stopped or boluses are missed. Severe high blood sugars and DKA can happen EVEN when blood sugar levels are normal or low at the time the insulin delivery stops. With the insulin pump, insulin delivery may be interrupted because of technical problems with: the infusion site (used for too long, irritated, infected) the cannula or tubing (poor connections, kinks, leaks) Author: Endocrinology and Metabolism, Alberta Health Services This material is for information purposes only. It should not be used in place of medical advice, instruction, or treatment. If you have questions, talk with your doctor or appropriate healthcare provider. This information may be printed and distributed without permission for non-profit, education purposes. The content on this page may not be changed without consent of the author. Contact [email protected] . Continue reading >>

Diabetic Ketoacidosis: A Serious Complication

Diabetic Ketoacidosis: A Serious Complication

A balanced body chemistry is crucial for a healthy human body. A sudden drop in pH can cause significant damage to organ systems and even death. This lesson takes a closer look at a condition in which the pH of the body is severely compromised called diabetic ketoacidosis. Definition Diabetic ketoacidosis, sometimes abbreviated as DKA, is a condition in which a high amount of acid in the body is caused by a high concentration of ketone bodies. That definition might sound complicated, but it's really not. Acidosis itself is the state of too many hydrogen ions, and therefore too much acid, in the blood. A pH in the blood leaving the heart of 7.35 or less indicates acidosis. Ketones are the biochemicals produced when fat is broken down and used for energy. While a healthy body makes a very low level of ketones and is able to use them for energy, when ketone levels become too high, they make the body's fluids very acidic. Let's talk about the three Ws of ketoacidosis: who, when, and why. Type one diabetics are the group at the greatest risk for ketoacidosis, although the condition can occur in other groups of people, such as alcoholics. Ketoacidosis usually occurs in type one diabetics either before diagnosis or when they are subjected to a metabolic stress, such as a severe infection. Although it is possible for type two diabetics to develop ketoacidosis, it doesn't happen as frequently. To understand why diabetic ketoacidosis occurs, let's quickly review what causes diabetes. Diabetics suffer from a lack of insulin, the protein hormone responsible for enabling glucose to get into cells. This inability to get glucose into cells means that the body is forced to turn elsewhere to get energy, and that source is fat. As anyone who exercises or eats a low-calorie diet knows, fa Continue reading >>

Ketoacidosis During A Low-carbohydrate Diet

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 >>

Ketoacidosis

Ketoacidosis

ketoacidosis [ke″to-as″ĭ-do´sis] the accumulation of ketone bodies in the blood, which results in metabolic acidosis; it is often associated with uncontrolled diabetes mellitus. See also ketosis. Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved. ke·to·ac·i·do·sis (kē'tō-as'i-dō'sis), Acidosis, as in diabetes or starvation, caused by the enhanced production of ketone bodies. ketoacidosis /ke·to·ac·i·do·sis/ (ke″to-as″ĭ-do´sis) acidosis accompanied by the accumulation of ketone bodies in the body tissues and fluids. ketoacidosis (kē′tō-ăs′ĭ-dō′sĭs) n. pl. ketoaci·doses (-dō′sēz) 1. Metabolic acidosis caused by an abnormally high concentration of ketone bodies in the blood and body tissues. 2. This condition occurring as a complication of untreated or improperly controlled diabetes mellitus, especially type 1 diabetes, characterized by thirst, fatigue, a fruity odor on the breath, and other symptoms, and having the potential to progress to coma or death. Also called diabetic ketoacidosis. ketoacidosis [kē′tōas′idō′sis] acidosis accompanied by an accumulation of ketones in the body, resulting from extensive breakdown of fats because of faulty carbohydrate metabolism. It occurs primarily as a complication of diabetes mellitus and is characterized by a fruity odor of acetone on the breath, mental confusion, dyspnea, nausea, vomiting, dehydration, weight loss, and, if untreated, coma. Emergency treatment includes the administration of insulin and IV fluids and the evaluation and correction of electrolyte imbalance. Nasogastric intubation and bladder catheterization may be required if the patient is comatose. Continue reading >>

Ketosis Vs Ketoacidosis: Is Keto Healthy?

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 >>

Diabetic Ketoacidosis (dka)

Diabetic Ketoacidosis (dka)

Topic Overview Diabetic ketoacidosis (DKA) is a life-threatening condition that develops when cells in the body are unable to get the sugar (glucose) they need for energy because there is not enough insulin. When the sugar cannot get into the cells, it stays in the blood. The kidneys filter some of the sugar from the blood and remove it from the body through urine. Because the cells cannot receive sugar for energy, the body begins to break down fat and muscle for energy. When this happens, ketones, or fatty acids, are produced and enter the bloodstream, causing the chemical imbalance (metabolic acidosis) called diabetic ketoacidosis. Ketoacidosis can be caused by not getting enough insulin, having a severe infection or other illness, becoming severely dehydrated, or some combination of these things. It can occur in people who have little or no insulin in their bodies (mostly people with type 1 diabetes but it can happen with type 2 diabetes, especially children) when their blood sugar levels are high. Your blood sugar may be quite high before you notice symptoms, which include: Flushed, hot, dry skin. Blurred vision. Feeling thirsty and urinating a lot. Drowsiness or difficulty waking up. Young children may lack interest in their normal activities. Rapid, deep breathing. A strong, fruity breath odor. Loss of appetite, belly pain, and vomiting. Confusion. How is DKA diagnosed? Laboratory tests, including blood and urine tests, are used to confirm a diagnosis of diabetic ketoacidosis. Tests for ketones are available for home use. Keep some test strips nearby in case your blood sugar level becomes high. When ketoacidosis is severe, it must be treated in the hospital, often in an intensive care unit. Treatment involves giving insulin and fluids through your vein and closely Continue reading >>

Ketoacidosis At First Presentation Of Type 1 Diabetes Mellitus Among Children: A Study From Kuwait

Ketoacidosis At First Presentation Of Type 1 Diabetes Mellitus Among Children: A Study From Kuwait

We examined the frequency and severity of diabetic ketoacidosis (DKA) in 679 children and adolescents (0–14 years) at diagnosis of Type 1 Diabetes Mellitus (T1DM) in Kuwait. Between 1st January 2011 and 31st December 2013, all newly diagnosed children with diabetes were registered prospectively in a population-based electronic register. DKA was diagnosed using standard criteria based on the levels of venous pH and serum bicarbonate. At the time of diagnosis, mild/moderate DKA was present in 24.8% of the children, while severe DKA was present in 8.8%. Incidence of ketoacidosis was significantly higher in young children less than 2 (60.7% vs 32.4% p = <0.005) compared to children 2–14 years old, and a higher proportion presented with severe DKA (21.4% vs 8.3% p = <0.05). No association was seen with gender. Significant differences were found in the incidence of DKA between Kuwaiti and non-Kuwaiti children (31.1% vs 39.8%; p < 0.05). Family history of diabetes had a protective effect on the occurrence of DKA (OR = 0.44; 95% CI = 0.27–0.71). Incidence of DKA in children at presentation of T1DM remains high at 33.6%. Prevention campaigns are needed to increase public awareness among health care providers, parents and school teachers in Kuwait. Diabetic ketoacidosis (DKA) is a serious life threatening complication of type 1 diabetes mellitus (T1DM) and constitutes a medical emergency with significant morbidity and mortality1, mostly due to cerebral edema during the course of resuscitation2,3. Worldwide, approximately 65,000 children aged under 15 years develop T1DM each year, and 13% to 80% of these children present with DKA at the time of diagnosis4. The highest frequencies for DKA at presentation of T1DM are seen in Saudi Arabia (44.9%)5, Taiwan (65%), Romania (67%), Continue reading >>

Understanding Sglt2 Inhibitors' Diabetic Ketoacidosis Risk

Understanding Sglt2 Inhibitors' Diabetic Ketoacidosis Risk

Deepali Dixit, PharmD, BCPS, is a Clinical Assistant Professor at Ernest Mario School of Pharmacy and a Clinical Critical Care Pharmacist in the Medical Intensive Care Unit at Robert Wood Johnson University Hospital. Dr. Dixit has been involved in multiple committees and in leadership positions in regional and national pharmacy and organizations. Dr. Dixit's research interests include sedation and delirium in the critically ill, infectious disease, alcohol withdrawal syndrome, chronic obstructive pulmonary disease, and patient safety. This article was collaboratively written with Shannon Anthony, PharmD Candidate. In May 2015, the FDA issued a warning about the risk of developing diabetic ketoacidosis while using SGLT2 inhibitors. That December, the FDA updated the drugs’ labels to include warnings about developing ketoacidosis even with near-normal blood glucose levels.1 SGLT2 inhibitors lower blood glucose levels by decreasing renal glucose reabsorption, which increases urinary glucose excretion.2 Three drugs in this class are currently available in the United States: canagliflozin (Invokana), dapagliflozin (Farxiga), and empagliflozin (Jardiance).1 These medications are approved for managing type 2 diabetes, although they’re increasingly used off-label to treat type 1 diabetes (T1D), and trials are currently being conducted to evaluate their efficacy for this potential indication.3 Diabetic ketoacidosis (DKA) develops most frequently in T1D patients secondary to omission or decreased dosage of insulin, acute illness, or a recent surgical procedure.4 The typical clinical presentation includes hyperglycemia (>250mg/dL), anion-gap acidosis, and elevated plasma and urine ketones.3 Early diagnosis and management of ketoacidosis is vital. The cornerstone DKA treatment Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

What Is It? Diabetic ketoacidosis is a potentially fatal complication of diabetes that occurs when you have much less insulin than your body needs. This problem causes the blood to become acidic and the body to become dangerously dehydrated. Diabetic ketoacidosis can occur when diabetes is not treated adequately, or it can occur during times of serious sickness. To understand this illness, you need to understand the way your body powers itself with sugar and other fuels. Foods we eat are broken down by the body, and much of what we eat becomes glucose (a type of sugar), which enters the bloodstream. Insulin helps glucose to pass from the bloodstream into body cells, where it is used for energy. Insulin normally is made by the pancreas, but people with type 1 diabetes (insulin-dependent diabetes) don't produce enough insulin and must inject it daily. Subscribe to Harvard Health Online for immediate access to health news and information from Harvard Medical School. Continue reading >>

What Is Ketoacidosis? A Comprehensive Guide

What Is Ketoacidosis? A Comprehensive Guide

Ketoacidosis is lethal. It is responsible for over 100,000 hospital admissions per year in the US with a mortality rate of around 5%. In other words, ketoacidosis is to blame for about 5,000 deaths per year. The cause? A deadly combination of uncontrolled hyperglycemia, metabolic acidosis, and increased ketone body levels in the blood (more on this deadly combination later). Luckily, this lethal triad rarely affects individuals who don’t have diabetes. However, the majority (80%) of cases of diabetic ketoacidosis occur in people with a known history of diabetes mellitus (any form of diabetes). Ketoacidosis vs. Diabetic Ketoacidosis — What’s The Difference? At this point, you may have noticed that I used ketoacidosis and diabetic ketoacidosis interchangeably. This is because it is difficult for the body to get into a state of ketoacidosis without the blood sugar control issues that are common in people with diabetes. Hence, the term diabetic ketoacidosis. (However, there is another form of ketoacidosis called alcoholic ketoacidosis. This occurs in alcoholics who had a recent alcohol binge during a period of time when they didn’t eat enough.) Ketoacidosis tends to occur the most in people who have type 1 diabetes. Somewhere between 5 and 8 of every 1,000 people with type 1 diabetes develops diabetic ketoacidosis each year. Type 2 diabetics also run the risk of ketoacidosis under stressful situations, but it is much rarer because type 2 diabetics have some remaining insulin production (type 1 diabetics do not). If you are not part of the 422 million people worldwide that have diabetes, your risk of getting ketoacidosis is negligible. You would have to put yourself through years of stress, inactivity, and unhealthy eating habits before you experience ketoacidosis. ( Continue reading >>

What Is Diabetic Ketoacidosis?

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 >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

DKA; Ketoacidosis; Diabetes - ketoacidosis Diabetic ketoacidosis is a life-threatening problem that affects people with diabetes. It occurs when the body cannot use sugar (glucose) as a fuel source because there is no insulin or not enough insulin. Fat is used for fuel instead. When fat is broken down to fuel the body, chemicals called ketones build up in the body. Various styles of insulin pumps may be utilized by people with diabetes to inject insulin into the body in a controlled, more convenient and discreet manner. During the oral glucose tolerance test your blood glucose is tested two hours after drinking 75 grams of glucose. You are diagnosed with diabetes if your blood glucose level is 200 mg/dl or greater. Various styles of insulin pumps may be utilized by people with diabetes to inject insulin into the body in a controlled, more convenient and discreet manner. Insulin is a hormone secreted by the pancreas in response to increased glucose levels in the blood. During the oral glucose tolerance test your blood glucose is tested two hours after drinking 75 grams of glucose. You are diagnosed with diabetes if your blood glucose level is 200 mg/dl or greater. Causes As fat is broken down, acids called ketones build up in the blood and urine. In high levels, ketones are poisonous. This condition is known as ketoacidosis. Diabetic ketoacidosis (DKA) is sometimes the first sign of type 1 diabetes in people who have not yet been diagnosed. It can also occur in someone who has already been diagnosed with type 1 diabetes. Infection, injury, a serious illness, missing doses of insulin shots, or surgery can lead to DKA in people with type 1 diabetes. People with type 2 diabetes can also develop DKA, but it is less common. It is usually triggered by uncontrolled blood sugar, Continue reading >>

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