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Ketoacidosis Can Result In

Is Keto Healthy? Ketosis Vs Ketoacidosis

Is Keto Healthy? Ketosis Vs Ketoacidosis

Is Keto Healthy? Ketosis vs Ketoacidosis When looking at a ketogenic diet and ketosis, it’s common for some people to confuse the process with a harmful, more extreme version of this state known as diabetic ketoacidosis. But there are a lot of misconceptions out there about ketosis vs ketoacidosis, and it’s time to shed some light on the subject by looking at the (very big) differences between the two. An Overview of Ketosis A ketogenic, or keto, diet is centered around the process of ketosis, so it’s important to understand exactly what ketosis is first before we get into whether or not it’s safe (spoiler: it is): Ketosis is a metabolic state where the body is primarily using fat for energy instead of carbohydrates. Burning carbohydrates (glucose) for energy is the default function of the body, so if glucose is available, the body will use that first. But during ketosis, the body is using ketones instead of glucose. This is an amazing survival adaptation by the body for handling periods of famine or fasting, extreme exercise, or anything else that leaves the body without enough glucose for fuel. Those eating a ketogenic diet purposely limit their carb intake (usually between 20 and 50 grams per day) to facilitate this response. That’s why the keto diet focuses on very low carb intake, moderate to low protein intake, and high intakes of dietary fats. Lower protein is important because it prevents the body from pulling your lean muscle mass for energy and instead turns to fat. Ketone bodies are released during ketosis and are created by the liver from fatty acids. These ketones are then used by the body to power all of its biggest organs, including the brain, and they have many benefits for the body we’ll get into later. But first, let’s address a common mi Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

DKA is an acute complication of diabetes mellitus (usually type 1 diabetes) characterized by hyperglycemia, ketonuria, acidosis, and dehydration. Insulin deficiency prevents glucose from being used for energy, forcing the body to metabolize fat for fuel. Free fatty acids, released from the metabolism of fat, are converted to ketone bodies in the liver. Increase in the secretion of glucagon, catecholamines, growth hormone, and cortisol, in response to the hyperglycemia caused by insulin deficiency, accelerates the development of DKA. Osmotic diuresis caused by hyperglycemia creates a shift in electrolytes, with losses in potassium, sodium, phosphate, and water. Serum glucose level is usually elevated over 300 mg/dL; may be as high as 1,000 mg/dL. Serum bicarbonate and pH are decreased due to metabolic acidosis, and partial pressure of carbon dioxide is decreased as a respiratory compensation mechanism. Serum sodium and potassium levels may be low, normal, or high due to fluid shifts and dehydration, despite total body depletion. Urine glucose is present in high concentration and specific gravity is increased, reflecting osmotic diuresis and dehydration. Observe for cardiac changes reflecting dehydration, metabolic acidosis, and electrolyte imbalance- hypotension; tachycardia; weak pulse; electrocardiographic changes, including elevated P wave, flattened T wave or inverted, prolonged QT interval. Administer replacement electrolytes and insulin as ordered. Flush the entire I.V. infusion set with solution containing insulin and discard the first 50 mL because plastic bags and tubing may absorb some insulin and the initial solution may contain decreased concentration of insulin. Continue reading >>

Ketoacidosis

Ketoacidosis

GENERAL ketoacidosis is a high anion gap metabolic acidosis due to an excessive blood concentration of ketone bodies (keto-anions). ketone bodies (acetoacetate, beta-hydroxybutyrate, acetone) are released into the blood from the liver when hepatic lipid metabolism has changed to a state of increased ketogenesis. a relative or absolute insulin deficiency is present in all cases. CAUSES The three major types of ketosis are: (i) Starvation ketosis (ii) Alcoholic ketoacidosis (iii) Diabetic ketoacidosis STARVATION KETOSIS when hepatic glycogen stores are exhausted (eg after 12-24 hours of total fasting), the liver produces ketones to provide an energy substrate for peripheral tissues. ketoacidosis can appear after an overnight fast but it typically requires 3 to 14 days of starvation to reach maximal severity. typical keto-anion levels are only 1 to 2 mmol/l and this will usually not alter the anion gap. the acidosis even with quite prolonged fasting is only ever of mild to moderate severity with keto-anion levels up to a maximum of 3 to 5 mmol/l and plasma pH down to 7.3. ketone bodies also stimulate some insulin release from the islets. patients are usually not diabetic. ALCOHOLIC KETOSIS Presentation a chronic alcoholic who has a binge, then stops drinking and has little or no oral food intake for a few days (ethanol and fasting) volume depletion is common and this can result in increased levels of counter regulatory hormones (eg glucagon) levels of free fatty acids (FFA) can be high (eg up to 3.5mM) providing plenty of substrate for the altered hepatic lipid metabolism to produce plenty of ketoanions GI symptoms are common (eg nausea, vomiting, abdominal pain, haematemesis, melaena) acidaemia may be severe (eg pH down to 7.0) plasma glucose may be depressed or normal or Continue reading >>

Diabetic Ketoacidosis Treatment

Diabetic Ketoacidosis Treatment

Diabetic ketoacidosis is a life-threatening medical condition that is a complication of diabetes mellitus that is not in control. It is more common among type 1 diabetics that have no insulin but it can also be seen in severe cases of type 2 diabetes. In diabetic ketoacidosis, there are ketones in the bloodstream and urine because the fat in the body is broken down with ketones as a byproduct. Diabetic ketoacidosis occurs when the body isn’t making enough insulin by the pancreatic islet cells. In a normal person, insulin is secreted by the pancreas in response to elevated blood sugar levels. The insulin helps glucose (sugar) to enter the cells to be used as cellular fuel. If insulin is absent, the body breaks down fatty acids to be used for fuel. Ketones build up in the urine and blood, leading to the condition known as diabetic ketoacidosis. The main cause is being a type 1 diabetic who has not taken enough insulin. Symptoms of Diabetic Ketoacidosis The signs and symptoms of diabetic ketoacidosis can come on suddenly, within a day or so of having no insulin. When signs and symptoms do show up, the patient may have any or all of the following symptoms: Confusion Breath that smells fruity Shortness of breath Tiredness or weakness Pain in the abdomen Nausea and vomiting Increased frequency of urination Being excessively thirsty Clinical signs that the individual has diabetic ketoacidosis includes have extremely high blood sugar levels as well as elevated levels of ketones in the urine. Causes of Diabetic Ketoacidosis The main source of cellular fuel is glucose. All of the cells of the body rely on glucose to make energy to allow the cells to function in whatever capacity they happen to be in. When insulin is lacking, the body is unable to use glucose as fuel. These caus Continue reading >>

Diabetic Ketoacidosis (dka)

Diabetic Ketoacidosis (dka)

Diabetic ketoacidosis, also called DKA, is a life-threatening complication occurring with undiagnosed and/or untreated Type 1 diabetes in adults and children. DKA symptoms often remain undiagnosed because they can look like (mimic) influenza, a stomach bug, strep infections, and other common illnesses and conditions. However, someone may actually have a common illness and DKA at the same time, causing the common illness symptoms to hide (mask) the underlying DKA symptoms. Either way, untreated Type 1 diabetes and DKA are 100% fatal. ​IMPORTANT: Diabetic ketoacidosis is LIFE-THREATENING and can progress quickly–often within 24 hours! If you or a loved one have any of the following symptoms with VOMITING AND LETHARGY COMBINED WITH LABORED BREATHING, do not consume sugar and seek emergency medical care immediately. Insist medical personnel Test One Drop of blood or urine for glucose (sugar) levels. DKA can be fatal! ​ SYMPTOMS OF DKA: excessive thirst frequent urination or bedwetting increased appetite or sugar cravings abdominal pain irritability, grouchiness, or mood changes headaches and/or vision changes itchy skin/genitals (yeast or thrush) sudden weight loss flushed, hot, dry skin nausea and vomiting* fruity/acetone scented breath* lethargy, drowsiness, or fatigue* labored, rapid, and/or deep breathing* confusion, stupor, or unconsciousness* *A combination of any of these symptoms can be life-threatening. Seek EMERGENCY CARE. When new onset Type 1 diabetes remains undiagnosed and untreated the shortage of insulin causes blood glucose (sugar) levels to climb above the normal range. Without adequate insulin to regulate levels of glucose in the blood, high levels of acids called ketones build up in the body causing diabetic ketoacidosis. Ketones are toxic and if l Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Diabetes mellitus is the name given to a group of conditions whose common hallmark is a raised blood glucose concentration (hyperglycemia) due to an absolute or relative deficiency of the pancreatic hormone insulin. In the UK there are 1.4 million registered diabetic patients, approximately 3 % of the population. In addition, an estimated 1 million remain undiagnosed. It is a growing health problem: In 1998, the World Health Organization (WHO) predicted a doubling of the worldwide prevalence of diabetes from 150 million to 300 million by 2025. For a very tiny minority, diabetes is a secondary feature of primary endocrine disease such as acromegaly (growth hormone excess) or Cushing’s syndrome (excess corticosteroid), and for these patients successful treatment of the primary disease cures diabetes. Most diabetic patients, however, are classified as suffering either type 1 or type 2 diabetes. Type 1 diabetes Type 1 diabetes, which accounts for around 15 % of the total diabetic population, is an autoimmune disease of the pancreas in which the insulin-producing β-cells of the pancreas are selectively destroyed, resulting in an absolute insulin deficiency. The condition arises in genetically susceptible individuals exposed to undefined environmental insult(s) (possibly viral infection) early in life. It usually becomes clinically evident and therefore diagnosed during late childhood, with peak incidence between 11 and 13 years of age, although the autoimmune-mediated β-cell destruction begins many years earlier. There is currently no cure and type 1 diabetics have an absolute life-long requirement for daily insulin injections to survive. Type 2 diabetes This is the most common form of diabetes: around 85 % of the diabetic population has type 2 diabetes. The primary prob Continue reading >>

Diabetic Coma Recovery: What You Need To Know

Diabetic Coma Recovery: What You Need To Know

In people with diabetes, a diabetic coma occurs when severe levels of either high or low uncontrolled blood sugar are not corrected. If treated quickly, a person will make a rapid recovery from a diabetic coma. However, diabetic coma can be fatal or result in brain damage. It is important for people with diabetes to control their blood sugars and know what to do when their blood sugar levels are not within their target range. The severe symptoms of uncontrolled blood sugar that can come before a diabetic coma include vomiting, difficulty breathing, confusion, weakness, and dizziness. Recovery from diabetic coma If a diabetic coma is not treated within a couple of hours of it developing, it can cause irreversible brain damage. If no treatment is received, a diabetic coma will be fatal. In addition, having blood sugar levels that continue to be too low or too high can be bad for long-term health. This remains true even if they do not develop into diabetic coma. Recognizing the early signs of low or high blood sugar levels and regular monitoring can help people with diabetes keep their blood sugar levels within the healthy range. Doing so will also reduce the risk of associated complications and diabetic coma. What is diabetes? Diabetes is a long-term condition in which the body is unable to control the level of a sugar called glucose in the blood. Diabetes is caused by either a lack of insulin, the body's inability to use insulin correctly, or both. In people who don't have diabetes, insulin usually ensures that excess glucose is removed from the bloodstream. It does this by stimulating cells to absorb the glucose they need for energy from the blood. Insulin also causes any remaining glucose to be stored in the liver as a substance called glycogen. The production of insul Continue reading >>

Severe Hypoglycemia And Diabetic Ketoacidosis In Adults With Type 1 Diabetes: Results From The T1d Exchange Clinic Registry

Severe Hypoglycemia And Diabetic Ketoacidosis In Adults With Type 1 Diabetes: Results From The T1d Exchange Clinic Registry

Severe Hypoglycemia and Diabetic Ketoacidosis in Adults With Type 1 Diabetes: Results From the T1D Exchange Clinic Registry State University of New York Upstate Medical University (R.S.W.), Syracuse, New York 13210 Search for other works by this author on: Jaeb Center for Health Research (D.X., S.N.D., K.M.M., R.W.B.), Tampa, Florida 33647 Search for other works by this author on: Barbara Davis Center for Childhood Diabetes (D.M.M., A.M.), Aurora, Colorado 80045 Search for other works by this author on: Barbara Davis Center for Childhood Diabetes (D.M.M., A.M.), Aurora, Colorado 80045 Search for other works by this author on: University of Pennsylvania School of Medicine (M.R.R.), Philadelphia, Pennsylvania 19104 Search for other works by this author on: Keck School of Medicine of the University of Southern California (A.L.P.), Los Angeles, California 90211 Search for other works by this author on: International Diabetes Center Park Nicollet (R.M.B.), Stanford, California 55416 Search for other works by this author on: Minneapolis, Minnesota; and Stanford University (B.H.), Stanford, California 55416 Search for other works by this author on: Jaeb Center for Health Research (D.X., S.N.D., K.M.M., R.W.B.), Tampa, Florida 33647 Search for other works by this author on: Jaeb Center for Health Research (D.X., S.N.D., K.M.M., R.W.B.), Tampa, Florida 33647 Address all correspondence and requests for reprints to: Kellee M. Miller, Jaeb Center for Health Research, 15310 Amberly Drive, Suite 350, Tampa, Florida 33647. Search for other works by this author on: Jaeb Center for Health Research (D.X., S.N.D., K.M.M., R.W.B.), Tampa, Florida 33647 Search for other works by this author on: Search for other works by this author on: The Journal of Clinical Endocrinology & Metabolism, Vo 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 >>

Diabetic Ketoacidosis Causes

Diabetic Ketoacidosis Causes

Diabetic ketoacidosis (DKA) is a dangerous complication of diabetes mellitus brought about by a lack of insulin in the body causing an inadequate uptake of glucose from the blood. It is characterized by a severe rise in blood sugar or hyperglycemia along with dehydration that may lead to shock and even loss of consciousness. Insulin is an important hormone that helps the body uptake and utilize glucose present in blood, therefore reducing the blood sugar level. If there is a lack of insulin, the blood sugar is not used and instead body fats are broken down to provide an alternative energy source. This breakdown of fat however, causes the release of acidic by-products called ketones that build up in the blood and urine. High glucose levels cause increased amounts of glucose to move into the urine, a process termed osmotic diuresis. During osmotic diuresis, water and solutes such as potassium and sodium also move into the urine. This leads to frequent excretion of large volumes of urine or polyuria, dehydration and compensatory thirst or polydypsia. Who is affected? DKA is more common among people with type 1 diabetes or those with type 2 diabetes who take insulin to regulate their blood sugar levels. Nearly a quarter of all type 1 diabetics are admitted to hospital with DKA at some point in their lives. Young children with type 1 diabetes are at particular risk of developing the condition. Causes Common causes or triggers of DKA typically include situations that raise the body's requirement for insulin. Examples include: Acute infection During infection, the body has an increased need for glucose that may not be met by an adequate amount of insulin for stimulating the uptake of glucose from the blood. Examples of infections that can cause this problem include the flu, ur Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Diabetic Ketoacidosis Definition Diabetic ketoacidosis is a dangerous complication of diabetes mellitus in which the chemical balance of the body becomes far too acidic. Description Diabetic ketoacidosis (DKA) always results from a severe insulin deficiency. Insulin is the hormone secreted by the body to lower the blood sugar levels when they become too high. Diabetes mellitus is the disease resulting from the inability of the body to produce or respond properly to insulin, required by the body to convert glucose to energy. In childhood diabetes, DKA complications represent the leading cause of death, mostly due to the accumulation of abnormally large amounts of fluid in the brain (cerebral edema). DKA combines three major features: hyperglycemia, meaning excessively high blood sugar kevels; hyperketonemia, meaning an overproduction of ketones by the body; and acidosis, meaning that the blood has become too acidic. Insulin deficiency is responsible for all three conditions: the body glucose goes largely unused since most cells are unable to transport glucose into the cell without the presence of insulin; this condition makes the body use stored fat as an alternative source instead of the unavailable glucose for energy, a process that produces acidic ketones, which build up because they require insulin to be broken down. The presence of excess ketones in the bloodstream in turn causes the blood to become more acidic than the body tissues, which creates a toxic condition. Causes and symptoms DKA is most commonly seen in individuals with type I diabetes, under 19 years of age and is usually caused by the interruption of their insulin treatment or by acute infection or trauma. A small number of people with type II diabetes also experience ketoacidosis, but this is rare give Continue reading >>

Cardiovascular Complications Of Ketoacidosis

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 >>

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 >>

High Alert: The Emergency Complications Of Diabetes

High Alert: The Emergency Complications Of Diabetes

Diabetes has become such a chronic long-term condition that it’s easy to forget about the serious acute complications that can arise, which can lead to a coma or death if not treated. There are only two types of emergencies – having very high glucose and having a very low glucose. The warning signs of an looming coma range from a mild headache to hallucinations.. If not identified or treated both types of emergencies can lead to serious irreversible complications including brain damage, kidney failure and death. When your glucose is very very high The fundamental issue in diabetes is raised blood glucose levels. Medically this is called hyperglycaemia. When glucose rises very rapidly or to very high levels, it can result in a diabetic ketoacidotic coma or a hyperglycaemic coma. Diabetic ketoacidotic coma This happens in type 1 diabetes and the high risk people include children and teens. A person can go into a ketoacidotic coma within a few hours. A person in a ketoacidotic crisis presents with: a complete lack of insulin in the body very high glucose levels dehydration break down of muscle abnormal potassium, sodium and other electrolyte levels. Causes of ketoacidotic crisis or coma A person who hasn’t been diagnosed with diabetes as yet Missing an insulin dose Illness such as gastroenteritis, nausea and vomiting Not adjusting insulin when glucose is high What to look out for if you suspect you may be going into a ketoacidotic crisis or coma Shortness of breath Fruity smelling breath Nausea and vomiting Severe fatigue Abdominal pain and headache Thirst Passing urine more often. Danger signs to watch out for Slurred speech Blurred vision Reduced concentration Coma. What you must do if yoususpect you may be going into a ketoacidotic crisis or coma Get to a casualty Continue reading >>

Ketosis Vs. Ketoacidosis: Understanding The Differences

Ketosis Vs. Ketoacidosis: Understanding The Differences

Introduction to Ketosis vs Ketoacidosis Historically, ketosis has been one of the most vaguely defined and poorly understood concepts of the last century. There are different scenarios in which are body can be in a state of ketosis (including ketoacidosis). The most basic definition of ketosis is a general increase in blood levels of ketone bodies to 0.5 mmol or above. However, the reasons for the development of ketosis, the resultant levels of blood ketones, and the associated outcomes (health versus possible death) differ drastically between different situations of ketosis. Failure to understand the differences between various incidents of ketosis has led to the common misconceptions we have today that ultimately has made educating the masses on the ketogenic diet difficult. The single most important take home from this article should be that diabetic ketoacidosis is not the same as the ketosis experienced from a ketogenic diet. Diabetic Ketoacidosis Whenever I speak about ketogenic dieting, almost inevitably I am asked the question: “But shouldn’t you be worried about going into a state of ketoacidosis?” Ketoacidosis occurs when the formation ketone bodies are uncontrolled (15-25 mmol) and acidity in the blood increases (1). It is important to understand that our body regulates blood acid concentrations tightly. We typically measure blood acidity vs. alkalinity using the pH scale. If your blood’s pH is less than 7 it is acidic, and if greater it is basic, or alkaline. Our blood is usually slightly alkaline with a pH ranging from 7.35 to 7.45. Any deviation up or down from the norm by even the smallest amount can prove fatal! The most common form of ketoacidosis to occur is known as diabetic ketoacidosis. This usually occurs in type I diabetics but can also oc Continue reading >>

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