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Ketoacidosis Word Parts

Dr. Ambrish Mithal Diabetic Ketoacidosis

Dr. Ambrish Mithal Diabetic Ketoacidosis

Iodine is an essential part of the chemical structure of thyroid hormones. The thyroid is a butterfly-shaped gland in the front part of the neck. It produces two hormones, thyroxine (T4) and triiodothyronine (T3), that are released into the bloodstream and carried to target organs, particularly the liver, kidneys, muscles, heart, and developing brain. We need iodine because thyroid hormones are essential to life. The thyroid hormones act in target organs by influencing many different chemical reactions, usually involving manufacture of key proteins. The body must have proper levels of thyroid hormone to function well. What happens if we don't get enough iodine? The most damaging consequences are on fetal and infant development. Maternal iodine deficiency causes miscarriages, other pregnancy complications, and infertility. Thyroid hormones, and therefore iodine, are essential for normal development of the brain. If the fetus or newborn is not exposed to enough thyroid hormone, it may have permanent mental retardation, even if it survives Low birth weights and decreased child survival also result from iodine deficiency. Cretinism is a very severe degree of this brain damage; it includes permanent dense mental retardation, and varying degrees of additional developmental defects such as deafmutism, short stature, spasticity, and other neuromuscular abnormalities. The most visible consequence of iodine deficiency is goiter. This word means "an enlarged thyroid." The process begins as an adaptation in which the thyroid is more active in its attempts to make enough thyroid hormone for the body's needs, despite the limited supply of raw material (iodine), much as a muscle gets bigger when it has to do more work. Most people who have previously been iodine sufficient can safely Continue reading >>

Diabetes Glossary

Diabetes Glossary

Antibodies Antibodies are specialized proteins that are part of the immune system. They are created when an antigen (such as a virus or bacteria) is detected in the body. The antibodies bond with the specific antigen that triggered their production, and that action neutralizes the antigen, which is a threat to the body. Antibodies are created to fight off whatever has invaded the body. See also autoantibodies. Antigens An antigen is a foreign substance (such as a virus or bacteria) that invades the body. When the body detects it, it produces specific antibodies to fight off the antigen. Autoantibodies Autoantibodies are a group of antibodies that “go bad” and mistakenly attack and damage the body’s tissues and organs. In the case of type 1 diabetes, autoantibodies attack the insulin producing beta cells in the pancreas. Autoimmune disorder If you have an autoimmune disorder (also called an autoimmune disease), your body’s immune system turns against itself and starts to attack its own tissues. Basal secretion (basal insulin) We all should have a small amount of insulin that’s constantly present in the blood; that is the basal secretion. People with type 1 diabetes must take a form of insulin that replicates the basal secretion throughout the day; that’s basal insulin. Beta cells Beta cells are located in the islets of Langerhans in the pancreas. They are responsible for making insulin. Blood glucose level The blood glucose level is how much glucose is in your blood at a given time. This level is very important for people with diabetes, and they must monitor their blood glucose level throughout the day. If the blood glucose level is too high (hyperglycemia), that means that there isn’t enough insulin in the blood. If it’s too low (hypoglycemia), that mean Continue reading >>

Hcc University: Coding Clinic Clarifies Diabetes And Complications, Ketoacidosis, And Anti-mag Polyneuropathy

Hcc University: Coding Clinic Clarifies Diabetes And Complications, Ketoacidosis, And Anti-mag Polyneuropathy

SCAN is committed to partnering with our physician providers in offering high quality geriatric care to our members. A significant part of that effort is to assist our providers in the provision of accurate coding that will contribute to the quality of care and support the expected revenue from the Medicare program. To this end, we present the following tools and education for all the physicians and groups providing care to our members. Coding Clinic Clarifies Diabetes and Complications, Ketoacidosis, and Anti-MAG Polyneuropathy Apparently the Q1 2016 "clarification" of diabetes with associated conditions confused many people. In Q2, 2016, Coding Clinic furthers their clarification by stating: "The subterm "with" in the Index should be interpreted as a link between diabetes and any of those conditions indented under the word "with." The physician documentation does not need to provide a link ..... These conditions should be coded as related even in the absence of provider documentation explicitly linking them, unless the documentation clearly states the conditions are unrelated.... For conditions not specifically linked by these relational terms in the classification, provider documentation must link the conditions in order to code them as related." Coders will have to look to the Index and/or the code description for the term "with" in order to make the determination whether or not the physician must specifically link the diabetes to the complication. Coding Clinic also addressed Ketoacidosis in Diabetes. They noted that physicians should be queried if they do not specify the type (i.e. Type 1 or Type 2) of diabetes. In most cases, when a physician does not state the type of diabetes, the default is Type 2, due to coding rules. However, ketoacidosis occurs most freque Continue reading >>

Diagnosis And Treatment Of Diabetic Ketoacidosis And The Hyperglycemic Hyperosmolar State

Diagnosis And Treatment Of Diabetic Ketoacidosis And The Hyperglycemic Hyperosmolar State

Diagnosis and treatment of diabetic ketoacidosis and the hyperglycemic hyperosmolar state Jean-Louis Chiasson, Nahla Aris-Jilwan, Raphal Blanger, Sylvie Bertrand, Hugues Beauregard, Jean-Marie ko, Hlne Fournier and Jana Havrankova DIABETIC KETOACIDOSIS AND THE HYPERGLYCEMIC hyperosmolar state are the most serious complications of diabetic decompensation and remain associated with excess mortality. Insulin deficiency is the main underlying abnormality. Associated with elevated levels of counterregulatory hormones, insulin deficiency can trigger hepatic glucose production and reduced glucose uptake, resulting in hyperglycemia, and can also stimulate lipolysis and ketogenesis, resulting in ketoacidosis. Both hyperglycemia and hyperketonemia will induce osmotic diuresis, which leads to dehydration. Clinical diagnosis is based on the finding of dehydration along with high capillary glucose levels with or without ketones in the urine or plasma. The diagnosis is confirmed by the blood pH, serum bicarbonate level and serum osmolality. Treatment consists of adequate correction of the dehydration, hyperglycemia, ketoacidosis and electrolyte deficits. Continue reading >>

Is Ketosis Dangerous?

Is Ketosis Dangerous?

You may have heard from your doctor that ketosis is a life-threatening condition. If so, your doctor is confusing diabetic ketoacidosis (DKA) with nutritional ketosis, or keto-adaptation. First, some semantics. Our body can produce, from fat and some amino acids, three ketone bodies (a “ketone” refers to the chemical structure where oxygen is double-bonded to carbon sandwiched between at least 2 other carbons). These ketone bodies we produce are: acetone, acetoacetone, and beta-hydroxybutyrate (B-OHB). [For anyone who is interested, they are the 3 most right structures on the figure, below.] Why do we make ketones? For starters, it’s a vital evolutionary advantage. Our brain can only function with glucose and ketones. Since we can’t store more than about 24 hours’ worth of glucose, we would all die of hypoglycemia if ever forced to fast for more than a day. Fortunately, our liver can take fat and select amino acids (the building blocks of proteins) and turn them into ketones, first and foremost to feed our brains. Hence, our body’s ability to produce ketones is required for basic survival. What is diabetic ketoacidosis? When diabetics (usually Type I diabetics, but sometimes this occurs in very late-stage, insulin-dependent, Type II diabetics) fail to receive enough insulin, they go into an effective state of starvation. While they may have all the glucose in the world in their bloodstream, without insulin, they can’t get any into their cells. Hence, they are effectively going into starvation. The body does what it would do in anyone – it starts to make ketones out of fat and proteins. Here’s the problem: the diabetic patient in this case can’t produce any insulin, so there is no feedback loop and they continue to produce more and more ketones withou Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) happens when your blood sugar is high and your insulin level is low. This imbalance in the body causes a build-up of ketones. Ketones are toxic. If DKA isn’t treated, it can lead to diabetic coma and even death. DKA mainly affects people who have type 1 diabetes. But it can also happen with other types of diabetes, including type 2 diabetes and gestational diabetes (during pregnancy). DKA is a very serious condition. If you have diabetes and think you may have DKA, contact your doctor or get to a hospital right away. The first symptoms to appear are usually: frequent urination. The next stage of DKA symptoms include: vomiting (usually more than once) confusion or trouble concentrating a fruity odor on the breath. The main cause of DKA is not enough insulin. A lack of insulin means sugar can’t get into your cells. Your cells need sugar for energy. This causes your body’s glucose levels to rise. To get energy, the body starts to burn fat. This process causes ketones to build up. Ketones can poison the body. High blood glucose levels can also cause you to urinate often. This leads to a lack of fluids in the body (dehydration). DKA can be caused by missing an insulin dose, eating poorly, or feeling stressed. An infection or other illness (such as pneumonia or a urinary tract infection) can also lead to DKA. If you have signs of infection (fever, cough, or sore throat), contact your doctor. You will want to make sure you are getting the right treatment. For some people, DKA may be the first sign that they have diabetes. When you are sick, you need to watch your blood sugar level very closely so that it doesn’t get too high or too low. Ask your doctor what your critical blood sugar level is. Most patients should watch their glucose levels c Continue reading >>

Our Diabetes Story: My 11 Year Old Son Went Into Diabetic Ketoacidosis And Was Diagnosed With Type 1 Diabetes

Our Diabetes Story: My 11 Year Old Son Went Into Diabetic Ketoacidosis And Was Diagnosed With Type 1 Diabetes

We had a really scary time this week — my 11-year-old son ended up in the Pediatric ICU at the local children’s hospital for two days due to Diabetic Ketoacidosis and we found out he has Type 1 Diabetes. I’m sharing our story because I missed obvious signs. Maybe another parent or caregiver might miss signs too. Maybe this will save a kid from going into Diabetic Ketoacidosis. While Type 1 Diabetes is not curable; maybe if I had put things together, we could have prevented a 2 day stay in the Pediatric Intensive Care unit. Our Diabetes Story: My 11 Year old Son Went Into Diabetic Ketoacidosis and Has Type 1 Diabetes According to the Juvenile Diabetes Research Foundation: “Knowing the warning signs for type 1 diabetes could help save a life! Type 1 diabetes can often go undiagnosed in its early stages because the symptoms can be mistaken for more common illnesses, like the flu. Take notice if you or your loved one experiences the following: Extreme thirst Frequent urination Drowsiness and lethargy Sugar in urine Sudden vision changes Increased appetite Sudden weight loss Fruity, sweet, or wine-like odor on breath Heavy, labored breathing Stupor or unconsciousness Call your doctor immediately if one or more of these symptoms occurs in you or your loved one. It is extremely important to receive medical attention—misdiagnosis or leaving your condition untreated can have tragic consequences, including death.” This is how we wound up at the hospital: Last Friday night B vomited (food) late at night. I didn’t think anything of it because he had eaten ice cream with his cousins and then miso soup and samosas for dinner. Crazy combination, right? He was fine all weekend after that and I was watching him closely. He seemed tired and very thirsty. (WARNING SIGNS). Ho Continue reading >>

> Hyperglycemia And Diabetic Ketoacidosis

> Hyperglycemia And Diabetic Ketoacidosis

When blood glucose levels (also called blood sugar levels) are too high, it's called hyperglycemia. Glucose is a sugar that comes from foods, and is formed and stored inside the body. It's the main source of energy for the body's cells and is carried to each through the bloodstream. But even though we need glucose for energy, too much glucose in the blood can be unhealthy. Hyperglycemia is the hallmark of diabetes — it happens when the body either can't make insulin (type 1 diabetes) or can't respond to insulin properly (type 2 diabetes). The body needs insulin so glucose in the blood can enter the cells to be used for energy. In people who have developed diabetes, glucose builds up in the blood, resulting in hyperglycemia. If it's not treated, hyperglycemia can cause serious health problems. Too much sugar in the bloodstream for long periods of time can damage the vessels that supply blood to vital organs. And, too much sugar in the bloodstream can cause other types of damage to body tissues, which can increase the risk of heart disease and stroke, kidney disease, vision problems, and nerve problems in people with diabetes. These problems don't usually show up in kids or teens with diabetes who have had the disease for only a few years. However, they can happen in adulthood in some people, particularly if they haven't managed or controlled their diabetes properly. Blood sugar levels are considered high when they're above someone's target range. The diabetes health care team will let you know what your child's target blood sugar levels are, which will vary based on factors like your child's age. A major goal in controlling diabetes is to keep blood sugar levels as close to the desired range as possible. It's a three-way balancing act of: diabetes medicines (such as in Continue reading >>

Caution: Don’t Get Caught With Ketones

Caution: Don’t Get Caught With Ketones

Ketoacidosis is an extremely serious diabetic complication that can lead to coma and even death. Unfortunately it is also fairly common. The good news, however, is that with proper care and an eye towards prevention, this costly and dangerous complication can be avoided. What Is Ketoacidosis? When there isn't enough insulin present for the metabolism of glucose, or when insufficient food has been eaten to satisfy energy requirements, the body burns fat for energy. Ketones are toxic, acidic byproducts of this process. Ketones are normally processed by the kidneys and excreted in the urine. But when more ketones are produced than the kidneys can handle, they can build up in the blood and lead to a dangerous condition known as diabetic ketoacidosis (DKA). Ketoacidosis raises the acidity of the body, which leads to "a cascade of problems throwing off a number a parameters in the body," says Cindy Onufer, RN, MA, CDE, the diabetes research and clinical care coordinator at Oregon Health Sciences University. Ketoacidosis rarely occurs in people with type 2 diabetes, who usually do not suffer from insufficiency of insulin, but is of great concern to those with type 1 diabetes. In fact, ketoacidosis is the number one cause of hospitalization for children with known diabetes in the United States. However, these hospitalizations are completely preventable if a urine ketone test is done and a care provider is called when indicated, says H. Peter Chase, MD, with the Barbara Davis Center for Childhood Diabetes in Denver, Colorado. Timely testing and prevention are of utmost importance as the condition can cause coma and death if proper treatment is not administered quickly. Higher ketone levels are a warning sign that your diabetes is out of control or that you may be in danger of ke Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

INTRODUCTION Diabetic ketoacidosis (DKA) is a very serious complication of diabetes mellitus, a metabolic disorder that is characterized by hyperglycemia, metabolic acidosis, and increased body ketone concentrations. The most common causes of DKA are infection and poor compliance with medication regimens. Other causes include undiagnosed diabetes, alcohol abuse, and a multitude of medical conditions such as cerebrovascular accident (CVA), complicated pregnancy, myocardial infarction, pancreatitis, and stress. Diabetic ketoacidosis is a complicated pathology. Early recognition of DKA, a good understanding of the pathological processes of DKA, and aggressive treatment are the keys to successful treatment. With good care, DKA can be managed and the patient will survive. OBJECTIVES When the student has finished studying this module, he/she will be able to: 1. Identify the correct definition of DKA. 2. Identify a basic function of insulin. 3. Identify the insulin derangements of types I and II diabetes. 4. Identify the basic cause of DKA. 5. Identify two specific causes of DKA. 6. Identify the two pathogenic mechanisms that produce the signs/symptoms of DKA. 7. Identify metabolic consequences of increased hormone concentrations in DKA. 8. Identify the criteria used to diagnose DKA. 9. Identify common signs and symptoms of DKA. 10. Identify laboratory abnormalities seen in DKA. 11. Identify complications of DKA. 12. Identify the three most important therapies for treating DKA. 13. Identify the correct roles of sodium bicarbonate and phosphate in treating DKA. 14. Identify an important rule for using potassium replacement in DKA. 15. Identify an important rule for switching from IV to subcutaneous insulin. EPIDEMIOLOGY Most cases of DKA are seen in patients with type I diabete Continue reading >>

Clinical Profile And Outcomes Of Paediatric Patients With Diabetic Ketoacidosis At A Tertiary Care Hospital In Pakistan

Clinical Profile And Outcomes Of Paediatric Patients With Diabetic Ketoacidosis At A Tertiary Care Hospital In Pakistan

Clinical profile and outcomes of paediatric patients with diabetic ketoacidosis at a tertiary care hospital in Pakistan Madiha Syed, Abdul Rashid, Khadija Nuzhat Humayun ( Department of Paediatrics and Child Health, Aga Khan University, Stadium Road, Karachi, Pakistan. ) Fariha Batool Khawaja, Taimur Saleem, Umair Khalid ( Medical Graduates, Class of 2009, Aga Khan University, Stadium Road, Karachi, Pakistan. ) Objectives: This study aims to present an experience in the management and clinical features of 88 children presenting with diabetic ketoacidosis (DKA) from Pakistan. Methods: A retrospective medical chart review of all patients, < 15 years of age, who presented to the Aga Khan University Hospital, Karachi, Pakistan in the last ten years with a diagnosis of diabetic ketoacidosis was carried out. Severity of DKA was defined as mild (venous pH<7.30 or bicarbonate=15mEq/l), moderate (venous pH<7.2 or bicarbonate= 10 mEq/l) and severe (venous pH <7 or bicarbonate < 5 mEq/l). These classes correspond to 1st, 2nd and 3rd degrees of diabetic ketoacidosis severity respectively. Cases in which diabetic ketoacidosis had occurred at onset of diabetic diagnosis were not included in the study. Results: Mean age was 7.5 3.6 years; 58 (66%) patients were male. Twenty six patients had mild diabetic ketoacidosis, 44 had moderate while 18 had severe diabetic ketoacidosis at the time of presentation. Severity of diabetic ketoacidosis was significantly associated with the presence of infection, history of omission of insulin, poor compliance, presence of shock at time of presentation, length of stay in the hospital, final outcome (p < 0.01 for each of these associations) and Glasgow Coma Scale score (p=0.02). Mortality in this series was 3.4%. Conclusion: Poor compliance was associ Continue reading >>

Alcoholic Ketoacidosis & Lacticacidosis

Alcoholic Ketoacidosis & Lacticacidosis

A 39 year-old female with a history of severe alcohol abuse presents to the ED with altered mental status. Her initial blood sugar is 57. A family member arrives to share that she has recently had epigastric pain and several episodes of emesis, limiting her alcohol intake. The patient is tachycardic, her blood pH is 7.4, lactate is 20, ketones are present in her serum, and she has an anion gap of 44. AT RISK: alcoholics who binge followed by several days of vomiting, decreased food intake, dehydration, and abstinence from alcohol CLINICAL EXAM FINDINGS: tachypnea, dehydration, ketonuria, serum glucose <200 mg/dL, typically normal blood pH despite ketonemia due to coexisting respiratory and metabolic alkalosis (vomiting) -the increased ketones are likely due to acute starvation in a patient who is chronically malnourished alcohol is metabolized by alcohol dehydrogenase using NAD+ as a cofactor to form acetaldehyde and NADH -the presence of NADH combines with pyruvate to form lactate and NAD+ -lactate cannot be metabolized in the reverse reaction without thiamine, a cofactor for pyruvate dehydrogenase Normal saline, thiamine (to metabolize the lactate), glucose, correction of electrolyte abnormalities (hypokalemia, hypomagnesemia) Clinical improvement is typically detected within hours of therapy, however these patients should be admitted for complete correction of fluid, electrolyte, and nutritional deficiencies Figure 1. The role of thiamine in aerobic metabolism. If glucose is administered without thiamine, the metabolic demand for thiamine increases, which may precipitate or worsen lactic acidosis. This may also trigger Wernicke-Korsakoff syndrome or wet or dry beriberi. Continue reading >>

Blood Ketones

Blood Ketones

On This Site Tests: Urine Ketones (see Urinalysis - The Chemical Exam); Blood Gases; Glucose Tests Elsewhere On The Web Ask a Laboratory Scientist Your questions will be answered by a laboratory scientist as part of a voluntary service provided by one of our partners, the American Society for Clinical Laboratory Science (ASCLS). Click on the Contact a Scientist button below to be re-directed to the ASCLS site to complete a request form. If your question relates to this web site and not to a specific lab test, please submit it via our Contact Us page instead. Thank you. Continue reading >>

Diabetic Ketoacidosis Glossary Of Terms

Diabetic Ketoacidosis Glossary Of Terms

Hypoglycemia: Low blood sugar (glucose). Hypoglycemia may be associated with symptoms such... See the entire definition of Hypoglycemia Infection: The invasion and multiplication of microorganisms such as bacteria, viruses, an... Injury: Harm or hurt. To harm, hurt, or wound. The word injure may be in physical or emot... Insulin: A natural hormone made by the pancreas that controls the level of the sugar gluco... Juvenile: Between infantile and adult. Used in medicine to indicate onset in childhood, as... Ketoacidosis: A feature of uncontrolled diabetes mellitus characterized by a combination o... See the entire definition of Ketoacidosis Ketone: A chemical substances that the body makes when it does not have enough insulin in ... Kidney: One of a pair of organs located in the right and left side of the abdomen. The kid... Laboratory: A place for doing tests and research procedures, and for preparing chemicals a... Liver: The largest solid organ in the body, situated in the upper part of the abdomen on t... Low blood pressure: Any blood pressure that is below the normal expected for an individua... Metabolism: The whole range of biochemical processes that occur within a living organism. ... Mouth: 1. The upper opening of the digestive tract, beginning with the lips and con... Muscle: Muscle is the tissue of the body which primarily functions as a source of power. T... Organic: 1. A chemical compound that contains carbon. Pain: An unpleasant sensation that can range from mild, localized discomfort to agony. Pa... Potassium: The major positive ion (cation) found inside cells. The chemical notation for p... Prognosis: The forecast of the probable outcome or course of a disease; the patient's chan... Regimen: A plan or a regulated course, such as a diet, exercise, or treat Continue reading >>

Diabetes Mellitus And Polyuria

Diabetes Mellitus And Polyuria

Diabetes comes from the Greek word which means “siphon”. There are two distinct disorders that share the first name diabetes: diabetes mellitus and diabetes insipidus. This is because both disorders cause polyuria, or excessive urine output. Diabetes insipidus is a disorder of urine concentration which we will discuss in spring quarter. Diabetes mellitus is a disorder of blood glucose regulation, which results from a deficiency in the action of the hormone insulin. This may be due to autoimmune destruction of the insulin-secreting cells of the pancreas (type 1 diabetes mellitus) or it may result from a problem in the responsiveness of tissues to insulin, known as insulin resitance (type 2 diabetes mellitus). With either disorder, the result is hyperglycemia, or high levels of glucose in the plasma. How does hyperglycemia cause excessive urine production? To answer this, we need to understand a little bit about how the kidney works. Each kidney contains about a million functional units called nephrons (blue structure in the figure). The first step in the production of urine is a process called filtration (green arrow). In filtration, there is bulk flow of water and small molecules from the plasma into Bowman’s capsule (the first part of the nephron). Because of the nonspecific nature of filtration, useful small molecules such as glucose, amino acids, and certain ions end up in the forming urine, which flows into the kidney tubules. To prevent the loss of these useful substances from the body, the cells lining the kidney tubules use epithelial transport to transfer these substances out of the forming urine and back into the extracellular fluid. This process is known as reabsorption (purple arrows). Under normal circumstances, 100% of the glucose that is filtered is Continue reading >>

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