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Ketoacidosis Pathophysiology

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What is DIABETIC KETOACIDOSIS? What does DIABETIC KETOACIDOSIS mean? DIABETIC KETOACIDOSIS meaning - DIABETIC KETOACIDOSIS definition - DIABETIC KETOACIDOSIS explanation. Source: Wikipedia.org article, adapted under https://creativecommons.org/licenses/... license. SUBSCRIBE to our Google Earth flights channel - https://www.youtube.com/channel/UC6Uu... Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes mellitus. Signs and symptoms may include vomiting, abdominal pain, deep gasping breathing, increased urination, weakness, confusion, and occasionally loss of consciousness. A person's breath may develop a specific smell. Onset of symptoms is usually rapid. In some cases people may not realize they previously had diabetes. DKA happens most often in those with type 1 diabetes, but can also occur in those with other types of diabetes under certain circumstances. Triggers may include infection, not taking insulin correctly, stroke, and certain medications such as steroids. DKA results from a shortage of insulin; in response the body switches to burning fatty acids which produces acidic ketone bodies. DKA is typically diagnosed when testing finds high blood sugar, low blood pH, and ketoacids in either the blood or urine. The primary treatment of DKA is with intravenous fluids and insulin. Depending on the severity, insulin may be given intravenously or by injection under the skin. Usually potassium is also needed to prevent the development of low blood potassium. Throughout treatment blood sugar and potassium levels should be regularly checked. Antibiotics may be required in those with an underlying infection. In those with severely low blood pH, sodium bicarbonate may be given; however, its use is of unclear benefit and typically not recommended. Rates of DKA vary around the world. About 4% of people with type 1 diabetes in United Kingdom develop DKA a year, while in Malaysia the condition affects about 25% a year. DKA was first described in 1886 and, until the introduction of insulin therapy in the 1920s, it was almost universally fatal. The risk of death with adequate and timely treatment is currently around 1–4%. Up to 1% of children with DKA develop a complication known as cerebral edema. The symptoms of an episode of diabetic ketoacidosis usually evolve over a period of about 24 hours. Predominant symptoms are nausea and vomiting, pronounced thirst, excessive urine production and abdominal pain that may be severe. Those who measure their glucose levels themselves may notice hyperglycemia (high blood sugar levels). In severe DKA, breathing becomes labored and of a deep, gasping character (a state referred to as "Kussmaul respiration"). The abdomen may be tender to the point that an acute abdomen may be suspected, such as acute pancreatitis, appendicitis or gastrointestinal perforation. Coffee ground vomiting (vomiting of altered blood) occurs in a minority of people; this tends to originate from erosion of the esophagus. In severe DKA, there may be confusion, lethargy, stupor or even coma (a marked decrease in the level of consciousness). On physical examination there is usually clinical evidence of dehydration, such as a dry mouth and decreased skin turgor. If the dehydration is profound enough to cause a decrease in the circulating blood volume, tachycardia (a fast heart rate) and low blood pressure may be observed. Often, a "ketotic" odor is present, which is often described as "fruity", often compared to the smell of pear drops whose scent is a ketone. If Kussmaul respiration is present, this is reflected in an increased respiratory rate.....

Childhood Ketoacidosis

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.[1]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 ensui Continue reading >>

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  1. Natalia & Enana

    Hi.
    I just put my cat in a veterinary emergency clinic with high ketoacidosis. They gave her an IV and insulin and other things I could afford. They told me to keep her there for 48 hours but I'm picking her up tomorrow and taking her to her vet. I dont know if my beautiful cat will survive. What are her chances? What are your suggestions.
    Thanks,
    Nat

  2. Sue and Oliver (GA)

    I am so sorry your kitty has DKA, Nat. It is possible to turn it around and she is in the best place to have that happen. We do have many cats who have survived and come home and lived long lives.
    What you can do - learn how to keep her safe at home. The best way to do that is to home test for blood glucose and for ketones. We test our cat's blood glucose levels just like we would our diabetic children. Here is a good site for beginning info: Newbie hometesting site and a video: Video for hometesting We have taught hundreds of people how to test over the internet. We would love to teach you. Testing for ketones will help you determine before DKA that he is heading into dangerous territory: ketones
    You can get the supplies for both these kinds of testing at any drug store. We use human glucometers and ketostix.
    Read about the best diet for your cat here: http://www.catinfo.org We feed wet lo carb food. BUT don't change the diet until you are hometesting. Oliver went down 100 points overnight when we switched from dry to wet. If we hadn't been hometesting, he would have overdosed.
    I am giving you a lot of info at once. The board is going down in 25 minutes and will be off for 2 hours for maintenance. Come back on later tonight or in the morning and post specifically for DKA. People who have dealt with it can give you lots of tips on how to care for your kitty when she gets home.

  3. Robert and Echo

    Nat, sending best wishes for your cat. Please keep us updated on her condition. Many cats do recover from DKA but, as you already know, it can be expensive treatment.
    _Rebecca

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Diabetic Ketoacidosis In Type 2 Diabetes Mellitus—pathophysiology And Clinical Presentation

SN Davis is supported by research grants from the NIH. GE Umpierrez is supported by research grants from the NIH, the American Diabetes Association, and the American Heart Association. The authors declare no competing financial interests. Continue reading >>

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  1. Jennifer72

    I notice the ketone blood test strips are cheaper on ebay these days...

    Probably has something to do with the new meter Jimmy Moore and others came out with? There is this new ketone meter (I forget the name of it) where the strips only cost $1 a piece.
    Ever since then, I've seen the Precision Xtra blood ketone strips on ebay for $1 instead of $2 a piece.
    $2 a piece was insane.. such a rip off!
    I think they are like 25 cents each in Australia right?

  2. AnnC

    Originally Posted by Jennifer72
    Probably has something to do with the new meter Jimmy Moore and others came out with? There is this new ketone meter (I forget the name of it) where the strips only cost $1 a piece.
    Ever since then, I've seen the Precision Xtra blood ketone strips on ebay for $1 instead of $2 a piece.
    $2 a piece was insane.. such a rip off!
    I think they are like 25 cents each in Australia right? I get my ketone strips for what I believe is the cheapest rate around - AUD 7.20 a box of 10. The chemist I get mine from always has the cheapest rate and will beat any genuine quote on anything. He has a tiny shop and has been doing this for a long time, making sure his rates are lower at all times than the big chains. He also allows me a Seniors discount on the ketone strips, in spite of the fact that this is not supposed to be allowed on them.
    The chain chemist just up the road in the shopping centre charges $10.00 per box.
    Current exchange rate is AUD 1.00 = USD 0.77

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Susan Cornell, PharmD, CDE, FAPhA, FAADE, describes the risks for ketoacidosis and serious urinary tract infection associated with use of SGLT2 inhibitors. This video was recorded at APhA's 2016 Annual Meeting and Exposition in Baltimore, Maryland.

Euglycemic Diabetic Ketoacidosis: A Predictable, Detectable, And Preventable Safety Concern With Sglt2 Inhibitors

The Case At Hand Recently, the U.S. Food and Drug Administration (FDA) issued a Drug Safety Communication that warns of an increased risk of diabetic ketoacidosis (DKA) with uncharacteristically mild to moderate glucose elevations (euglycemic DKA [euDKA]) associated with the use of all the approved sodium–glucose cotransporter 2 (SGLT2) inhibitors (1). This Communication was based on 20 clinical cases requiring hospitalization captured between March 2013 and June 2014 in the FDA Adverse Event Reporting System database. The scarce clinical data provided suggested that most of the DKA cases were reported in patients with type 2 diabetes (T2D), for whom this class of agents is indicated; most likely, however, they were insulin-treated patients, some with type 1 diabetes (T1D). The FDA also identified potential triggering factors such as intercurrent illness, reduced food and fluid intake, reduced insulin doses, and history of alcohol intake. The following month, at the request of the European Commission, the European Medicines Agency (EMA) announced on 12 June 2015 that the Pharmacovigilance Risk Assessment Committee has started a review of all of the three approved SGLT2 inhibitors Continue reading >>

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  1. owlright

    Getting rid of ketones?

    Anyone have advice for helping to get rid of ketones in the urine. I'm definitely not dehydrated - I drink a ton of water each day, completely avoid caffeine, and haven't been throwing up much or at all lately. My blood sugar is not high, completely within GD guidelines. So I'm thinking that the ketones must be from not getting enough carbs.
    I am eating as much as I can. I haven't had much of an appetite since becoming pregnant, but beyond that, I have delayed gastric empyting and severe reflux - so I really can't get more into my stomach. If I try for more volume of food, it will come back up.
    Suggestions for foods that have a bit more carbs without a ton of volume, and something that is less likely to spike my BS (I know this is individual).

    Relevant is that my GD is probably a result of long-time steroid use - going off the pred is not a possibility. I'm supposed to be trying to take in 175 g of carbs a day for the pregnancy. Right now I am making it to 100 on a good day (todays total is 89), and that is even with a late night (1 am) snack. My blood sugars are what I would consider to be good - has been between 78 and 85, and 2 hours pp has been between 93 and 117,

  2. mollythed

    I'm not used to thinking in terms of GD, but it seems to me that the ketones with lower blood glucose mean you are burning body fat instead of food for energy. Why not add more protein or fat instead of carbs? Does gastroparesis make that difficult?

  3. owlright

    Mollythed:

    I'm not used to thinking in terms of GD, but it seems to me that the ketones with lower blood glucose mean you are burning body fat instead of food for energy. Why not add more protein or fat instead of carbs? Does gastroparesis make that difficult?
    True - the ketones are likely a product of burning fat instead of food. Which would not be a horrible thing, generally, but most docs want you to avoid ketones, regardless of the cause, during pregnancy. There are some studies that say that they can have negative effects on the baby.

    If increasing other fat and protein will make them go away, I can probably swing that - at this point everything suggested to me has been that I need to eat more carbs. It is ok for me to lose a little bit of weight, because I'm overweight, but right now I'm losing at a rate that they are worried about.

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