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Ketoacidosis How To Treat

Diabetic Ketoacidosis Treatment & Management

Diabetic Ketoacidosis Treatment & Management

Approach Considerations Managing diabetic ketoacidosis (DKA) in an intensive care unit during the first 24-48 hours always is advisable. When treating patients with DKA, the following points must be considered and closely monitored: It is essential to maintain extreme vigilance for any concomitant process, such as infection, cerebrovascular accident, myocardial infarction, sepsis, or deep venous thrombosis. It is important to pay close attention to the correction of fluid and electrolyte loss during the first hour of treatment. This always should be followed by gradual correction of hyperglycemia and acidosis. Correction of fluid loss makes the clinical picture clearer and may be sufficient to correct acidosis. The presence of even mild signs of dehydration indicates that at least 3 L of fluid has already been lost. Patients usually are not discharged from the hospital unless they have been able to switch back to their daily insulin regimen without a recurrence of ketosis. When the condition is stable, pH exceeds 7.3, and bicarbonate is greater than 18 mEq/L, the patient is allowed to eat a meal preceded by a subcutaneous (SC) dose of regular insulin. Insulin infusion can be discontinued 30 minutes later. If the patient is still nauseated and cannot eat, dextrose infusion should be continued and regular or ultra–short-acting insulin should be administered SC every 4 hours, according to blood glucose level, while trying to maintain blood glucose values at 100-180 mg/dL. The 2011 JBDS guideline recommends the intravenous infusion of insulin at a weight-based fixed rate until ketosis has subsided. Should blood glucose fall below 14 mmol/L (250 mg/dL), 10% glucose should be added to allow for the continuation of fixed-rate insulin infusion. [19, 20] In established patient Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

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 >>

Treatment And Complications Of Diabetic Ketoacidosis In Children And Adolescents

Treatment And Complications Of Diabetic Ketoacidosis In Children And Adolescents

INTRODUCTION Diabetic ketoacidosis (DKA) is the leading cause of morbidity and mortality in children with type 1 diabetes mellitus (T1DM), with a case fatality rate ranging from 0.15 percent to 0.31 percent [1-3]. DKA also can occur in children with type 2 DM (T2DM); this presentation is most common among youth of African-American descent [4-8]. (See "Classification of diabetes mellitus and genetic diabetic syndromes".) The management of DKA in children will be reviewed here (table 1). There is limited experience in the management and outcomes of DKA in children with T2DM, although the same principles should apply. The clinical manifestations and diagnosis of DKA in children and the pathogenesis of DKA are discussed elsewhere. (See "Clinical features and diagnosis of diabetic ketoacidosis in children and adolescents" and "Diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults: Epidemiology and pathogenesis".) DEFINITION Diabetic ketoacidosis – A consensus statement from the International Society for Pediatric and Adolescent Diabetes (ISPAD) in 2014 defined the following biochemical criteria for the diagnosis of diabetic ketoacidosis (DKA) [9]: Hyperglycemia – Blood glucose of >200 mg/dL (11 mmol/L) AND Metabolic acidosis – Venous pH <7.3 or a plasma bicarbonate <15 mEq/L (15 mmol/L) AND Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Treatment Approach The main goals of treatment are: Restoration of volume deficits Resolution of hyperglycemia and ketosis/acidosis Correction of electrolyte abnormalities (potassium level should be >3.3 mEq/L before initiation of insulin therapy; use of insulin in a patient with hypokalemia may lead to respiratory paralysis, cardiac arrhythmias, and death) Treatment of the precipitating events and prevention of complications. It must be emphasized that successful treatment requires frequent monitoring of clinical and laboratory parameters to achieve resolution criteria. A treatment protocol and a flow sheet for recording the treatment stages and laboratory data should be maintained. [1] [38] [39] [40] Initial and supportive treatment The majority of patients present to the emergency department, where treatment should be initiated. There are several important steps that should be followed in early management: Fluid therapy should be started immediately after initial laboratory evaluations. Infusion of isotonic solution of 0.9% sodium chloride at a rate of 1 to 1.5 L/hour should be used for the first hour of fluid therapy. Indications for admission to the intensive care unit (ICU) are hemodynamic instability or cardiogenic shock, altered mental status, respiratory insufficiency, severe acidosis, and hyperosmolar state with coma. The diagnosis of hemodynamic instability should made by observing for hypotension and clinical signs of poor tissue perfusion, including oliguria, cyanosis, cool extremities, and altered mental state. After admission to ICU, central venous and arterial lines are required, with continuous percutaneous oximetry. Oxygenation and airway protection are critical. Intubation and mechanical ventilation are commonly required, with constant monitoring of r Continue reading >>

Diabetic Ketoacidosis: Evaluation And Treatment

Diabetic Ketoacidosis: Evaluation And Treatment

Diabetic ketoacidosis is characterized by a serum glucose level greater than 250 mg per dL, a pH less than 7.3, a serum bicarbonate level less than 18 mEq per L, an elevated serum ketone level, and dehydration. Insulin deficiency is the main precipitating factor. Diabetic ketoacidosis can occur in persons of all ages, with 14 percent of cases occurring in persons older than 70 years, 23 percent in persons 51 to 70 years of age, 27 percent in persons 30 to 50 years of age, and 36 percent in persons younger than 30 years. The case fatality rate is 1 to 5 percent. About one-third of all cases are in persons without a history of diabetes mellitus. Common symptoms include polyuria with polydipsia (98 percent), weight loss (81 percent), fatigue (62 percent), dyspnea (57 percent), vomiting (46 percent), preceding febrile illness (40 percent), abdominal pain (32 percent), and polyphagia (23 percent). Measurement of A1C, blood urea nitrogen, creatinine, serum glucose, electrolytes, pH, and serum ketones; complete blood count; urinalysis; electrocardiography; and calculation of anion gap and osmolar gap can differentiate diabetic ketoacidosis from hyperosmolar hyperglycemic state, gastroenteritis, starvation ketosis, and other metabolic syndromes, and can assist in diagnosing comorbid conditions. Appropriate treatment includes administering intravenous fluids and insulin, and monitoring glucose and electrolyte levels. Cerebral edema is a rare but severe complication that occurs predominantly in children. Physicians should recognize the signs of diabetic ketoacidosis for prompt diagnosis, and identify early symptoms to prevent it. Patient education should include information on how to adjust insulin during times of illness and how to monitor glucose and ketone levels, as well as i Continue reading >>

Were There Any American Citizens Living On Us Soil Who Died Because They Couldn't Afford Healthcare?

Were There Any American Citizens Living On Us Soil Who Died Because They Couldn't Afford Healthcare?

Various answers to answers (I guess coming from incredulous non-Americans) have asked why the American people would put up with such a system, or why anyone could think it is better than the “socialist” model. Some have mentioned the stigma associated with the word socialism which Americans have been indoctrinated with since the Cold War. While that is true, it’s important to consider where that message originated, and why it was spread. “Single payer” healthcare is paid for by tax revenue. Healthcare is expensive in any country compared to other parts of the federal budget like public building maintenance, forestry etc., so a significant percentage of all taxes collected go to pay for socialist healthcare. That applies to the taxes of a poor American who doesn’t pay any taxes (20% of zero is zero), just as it does to a wealthy “1%er”, or an ultra-wealthy billionaire like Trump or Koch. In the American private health insurance system, if your insurance for a family costs $20k per year, that’s your liability for private health insurance regardless of your income. Joe the Plummer or Mitt Romney or Bill Gates - That same insurance costs each of them $20k more or less. This is from the Fraser Institute (Conservative Canadian “think tank”): “The 10% of Canadian families with the lowest incomes will pay an average of about $477 for public health care insurance in 2015. The 10% of Canadian families who earn an average income of $59,666 will pay an average of $5,684 for public health care insurance and the families among the top 10% of income earners in Canada will pay $37,180.” For extremely high-income wealthy Americans like Koch or Trump, that number would be a lot higher. If 20% of tax revenue goes to pay for healthcare, and George Soros pays $100 Continue reading >>

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 >>

Management Of Feline Diabetic Ketoacidosis

Management Of Feline Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a complication of diabetes mellitus with concurrent and often severe metabolic derangements associated with hyperglycaemia, glucosuria, metabolic acidosis, ketonaemia +/- ketonuria. Patients with ketonaemia/ketosis are usually still bright, eating and maintaining their hydration. Those with ketoacidosis are dehydrated, clinically unwell (e.g., anorexia, vomiting, lethargy) and typically require hospitalisation and intensive management. DKA is distinguished from uncomplicated diabetes mellitus (DM) by a relative insulin lack and increased counter-regulatory hormones. The latter are thought to occur secondary to intercurrent disease. Concurrent disease has been documented in approximately 90% of cats with DKA, with the most common being hepatic lipidosis, chronic kidney disease, acute pancreatitis, bacterial or viral infections and neoplasia (Bruskiewicz et al. 1997). Heinz bodies, neutrophilia with a left shift, increased ALT and azotaemia is common. Most cats presenting with DKA are newly diagnosed diabetics or recently diagnosed but poorly controlled diabetics. Diagnosis Hyperglycaemia, Glucosuria, Metabolic Acidosis Plus Ketones in Plasma and/or Urine Traditionally DKA has been diagnosed using urinary ketone dipsticks, which detect acetoacetate but not beta-hydroxybutyrate. However as the latter is the principle ketone body in DKA, measuring serum beta-hydroxybutyrate is a more sensitive indicator of DKA. In humans portable meters that measure beta-hydroxybutyrate in whole blood have largely superseded urine dipsticks. These ketone meters have recently proven useful in diagnosing DKA in cats, although they tend to underestimate beta-hydroxybutyrate at higher values (Zeugswetter, Rebuzzi 2012; Weingart et al. 2012). In the absence of a ke 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. Your body needs a constant source of energy. When you have plenty of insulin, your body cells can get all the energy they need from glucose. If you don't have enough insulin in your blood, your liver is programmed to manufacture emergency fuels. These fuels, made from fat, are called ketones (or keto acids). In a pinch, ketones can give you energy. However, if your body stays dependent on ketones for energy for too long, you soon will become ill. Ketones are acidic chemicals that are toxic at high concentrations. In diabetic ketoacidosis, ketones build up in the blood, seriously altering the normal chemistry of the blood and interfering with the function of multiple organs. They make the blood acidic, which causes vomiting and abdominal pain. If the acid level of the blood becomes extreme, ketoacidosis can cause falling blood pressure, coma and death. Ketoacidosis is always accompanied by dehydration, which is caused by high Continue reading >>

Do You Have To Be Hospitalized To Get Your Sugar Regulated?

Do You Have To Be Hospitalized To Get Your Sugar Regulated?

It depends. How high is your blood sugar? Are you diagnosed as diabetic? How long? If you are newly diagnosed as Type 1, then you may be in ketoacidosis. That requires close monitoring. If you are just running high, you may be able to treat yourself- especially if you are already on insulin. If you have never been on insulin and your blood sugars are not terribly high, you may just check in regularly with your doctor. In other words, it doesn't mean an automatic hospital stay. But if you are dangerously high then a hospital stay is better than a coma. Continue reading >>

68..............................................................................................................................................................................navc Clinician’s Brief / April 2011 / Diagnostic Tree

68..............................................................................................................................................................................navc Clinician’s Brief / April 2011 / Diagnostic Tree

1. IV Isotonic Crystalloid Therapy • Shock fluid therapy is warranted if cardiovascular instability is present: Full shock dose of fluids is 90 mL/kg; start with ¼ to 1/3 dose and reassess until stable • Correct dehydration, provide maintenance needs, and replace ongoing losses over 6 to 24 hours: - % dehydration × body weight (kg) × 1000 plus - 20 mL/kg/day (insensible losses) plus - 20 to 40 mL/kg/day (maintenance sensible losses) plus - Account for vomiting, diarrhea, & polyuria (ongoing sensible losses) Alice Huang, VMD, & J. Catharine Scott-Moncrieff, Vet MB, MS, MA, Diplomate ACVIM & ECVIM Purdue University Canine Diabetic Ketoacidosis D i a gno s t i c Tre e / ENDOCRINOLOGY Peer Reviewed Physical Examination • Polyuria • Weight loss • Polydipsia • Vomiting • Polyphagia • Lethargy Patient may have only 1 or more of these signs. Laboratory Results • Blood glucose (BG): Hyperglycemia (> 200 mg/dL) • Blood gas (venous or arterial): Metabolic acidosis • Urine dipstick: Glucosuria; ketonuria or ketonemia Serum ketones can be measured if urine is unavailable. Diabetic Ketoacidosis Treatment 2. Electrolyte Supplementation (see Table 1, page 70) • Monitor serum potassium Q 4–6 H until within reference interval and stable; then Q 12–24 H • Monitor serum phosphorus Q 4–6 H until > 1.5; then Q 6–24 H • When supplementing potassium and phosphorus concurrently, take into account the amount of potassium contained in the potassium phosphate • Consider magnesium supplementation in instances of refractory hypokalemia 3. Regular Insulin • Continuous rate infusion (CRI) protocol:1 - Add 2.2 U/kg of regular insulin to 250 mL of 0.9% saline - Allow 50 Continue reading >>

Why Do We Throw Up When We Are Hung-over?

Why Do We Throw Up When We Are Hung-over?

1. The Body’s Reaction to Toxins An area of the brain, known as the vomiting center, alerts your body at once if any toxic substance enters your system. The vomiting center can be triggered by signals received from different parts of the body, such as the stomach, intestines, the balancing system and the blood stream. Alcohol ingestion is one of the triggers that can result in activation of the vomiting center. If the toxic level of alcohol is reached, the vomiting center will try to expel the excessive alcohol by making you throw up. 2. Gastroparesis Why do you throw up after drinking? Maybe the reason is gastroparesis. Alcohol intake causes the slowdown of the digestion in stomach (gastroparesis), which will lead to delayed stomach emptying. Since the digestion is slow, the proteins remaining in stomach will start to rot. The by-products of rotting are quite toxic and can trigger vomiting. 3. Alcohol Poisoning Alcohol poisoning is a potentially life-threatening result of alcohol drinking. Drinking excessive amounts of alcohol over a short span of time can exert adverse effects on gag reflex respiration, heart rate and body temperature. Coma and even death can occur if prompt treatment is not given. Except from vomiting, the signs and symptoms of alcohol poisoning also include delirium, seizures, low breathing rate (less than 8 breathes in a minute), pale or blue skin, cold extremities and fainting. 4. Alcoholic Ketoacidosis Why do you throw up after drinking? Alcoholic ketoacidosis may be one of the culprits. The cells need glucose and insulin to function well. Alcohol intake may cause the pancreas to cease the production of insulin. Then cells will start burning fats to obtain energy, which will generate by-products called ketones. Ketones are acidic in nature and Continue reading >>

Management Of Adult Diabetic Ketoacidosis

Management Of Adult Diabetic Ketoacidosis

Go to: Abstract Diabetic ketoacidosis (DKA) is a rare yet potentially fatal hyperglycemic crisis that can occur in patients with both type 1 and 2 diabetes mellitus. Due to its increasing incidence and economic impact related to the treatment and associated morbidity, effective management and prevention is key. Elements of management include making the appropriate diagnosis using current laboratory tools and clinical criteria and coordinating fluid resuscitation, insulin therapy, and electrolyte replacement through feedback obtained from timely patient monitoring and knowledge of resolution criteria. In addition, awareness of special populations such as patients with renal disease presenting with DKA is important. During the DKA therapy, complications may arise and appropriate strategies to prevent these complications are required. DKA prevention strategies including patient and provider education are important. This review aims to provide a brief overview of DKA from its pathophysiology to clinical presentation with in depth focus on up-to-date therapeutic management. Keywords: DKA treatment, insulin, prevention, ESKD Go to: Introduction In 2009, there were 140,000 hospitalizations for diabetic ketoacidosis (DKA) with an average length of stay of 3.4 days.1 The direct and indirect annual cost of DKA hospitalizations is 2.4 billion US dollars. Omission of insulin is the most common precipitant of DKA.2,3 Infections, acute medical illnesses involving the cardiovascular system (myocardial infarction, stroke) and gastrointestinal tract (bleeding, pancreatitis), diseases of the endocrine axis (acromegaly, Cushing’s syndrome), and stress of recent surgical procedures can contribute to the development of DKA by causing dehydration, increase in insulin counter-regulatory hor Continue reading >>

Type 2 Diabetes: Ketoacidosis

Type 2 Diabetes: Ketoacidosis

What is ketoacidosis, and how do you treat it? Ketoacidosis -- also known as diabetic ketoacidosis, or DKA -- occurs when harmfully high levels of ketones build up in the blood. Ketones are an acid produced when there's a shortage of insulin in the blood and the body is forced to break down fat, rather than glucose, for energy. Ketones can spill over into the urine when the body doesn't have enough insulin, and the effects can be deadly. The symptoms of ketoacidosis Blood sugar level higher than 300 milligrams per deciliter (mg/dL) Difficulty breathing, rapid breath, or shortness of breath Breath that smells fruity A very dry mouth Nausea and vomiting Difficulty concentrating Extreme fatigue, drowsiness, or weakness Rapid heartbeat and low blood pressure How to treat ketoacidosis Ketoacidosis is an emergency condition that requires immediate attention. Call 911 or take the person you're caring for to the nearest hospital. How to prevent ketoacidosis Make sure the person you're caring for drinks plenty of water so he stays hydrated and can flush the ketones out of his system. Check for ketones by doing a simple urine test. Test strips are available over the counter. Tell him to refrain from exercise if his blood glucose is 250 mg/dL or higher and ketones are present in his urine. Remind him to check his blood glucose often and to immediately report any sky-high readings to his main diabetes care provider. Sarah Henry has covered health stories for most of her more than two decades as a writer, from her ten-year stint at the award-winning Center for Investigative Reporting to her staff writer position with Hippocrates magazine to her most recent Web work for online sites, including WebMD, Babycenter. See full bio Continue reading >>

Must Read Articles Related To Diabetic Ketoacidosis

Must Read Articles Related To Diabetic Ketoacidosis

A A A Diabetic Ketoacidosis (cont.) Fluid replacement and insulin administration intravenously (IV) are the primary and most critical initial treatments for diabetic ketoacidosis. These therapies together reverse dehydration, lower blood acid levels, and restore normal sugar and electrolyte balance. Fluids must be administered wisely - not at an excessive rate or total volume due to the risk of brain swelling (cerebral edema). Potassium is typically added to IV fluids to correct total body depletion of this important electrolyte. Insulin must not be delayed and must be given promptly as a continuous infusion (not as a bolus - a large dose given rapidly) to stop further ketone formation and to stabilize tissue function by driving available potassium back inside the body's cells. Once blood glucose levels have fallen below 300mg/dL, glucose may be co-administered with ongoing insulin administration to avoid the development of hypoglycemia (low blood sugar). People diagnosed with diabetic ketoacidosis are usually admitted into the hospital for treatment and may be admitted to the intensive care unit. Some people with mild acidosis with modest fluid and electrolyte losses, and who can reliably drink fluid and follow medical instructions can be safely treated and sent home. Follow-up must be available with a health care practitioner. Individuals with diabetes who are vomiting should be admitted to the hospital or urgent care center for further observation and treatment. In cases of mild dehydration with borderline diabetic ketoacidosis, you may be treated and released from the emergency department providing that you are reliable and will promptly follow-up with your health care practitioner. Whether you are released to go home or monitored in the hospital, it is important th Continue reading >>

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