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Low Co2 In Dka

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Understanding The Presentation Of Diabetic Ketoacidosis

Hypoglycemia, diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar nonketotic syndrome (HHNS) must be considered while forming a differential diagnosis when assessing and managing a patient with an altered mental status. This is especially true if the patient has a history of diabetes mellitus (DM). However, be aware that the onset of DKA or HHNS may be the first sign of DM in a patient with no known history. Thus, it is imperative to obtain a blood glucose reading on any patient with an altered mental status, especially if the patient appears to be dehydrated, regardless of a positive or negative history of DM. In addition to the blood glucose reading, the history — particularly onset — and physical assessment findings will contribute to the formulation of a differential diagnosis and the appropriate emergency management of the patient. Pathophysiology of DKA The patient experiencing DKA presents significantly different from one who is hypoglycemic. This is due to the variation in the pathology of the condition. Like hypoglycemia, by understanding the basic pathophysiology of DKA, there is no need to memorize signs and symptoms in order to recognize and differentiate bet Continue reading >>

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Popular Questions

  1. Knicks

    In DKA, the patient is acidotic, right? So why would the body decrease bicarbonate (a base)? Wouldn't you want to keep the bicarbonate high so as to neutralize the acid?
    Too tired to think straight at the moment.

  2. generic

    The HCO3 derangement is not a compensation--it is the primary problem.
    DKA patients have a metabolic acidosis, I think it's mostly caused by the formation of tons and tons of ketone bodies (acidic). These are formed because despite high circulating levels of glucose, the cells can't use the glucose without insulin-->turn to ketone formation instead.
    The metabolic acidosis may cause respiratory compensation, which would give Kussmaul breathing, for example.

  3. treva

    Knicks said: ↑
    In DKA, the patient is acidotic, right? So why would the body decrease bicarbonate (a base)? Wouldn't you want to keep the bicarbonate high so as to neutralize the acid?
    Too tired to think straight at the moment. Remember the kidney takes days to compensate for acidodic state by producing more bicarb. Acutely, the bicarb is used to buffer the extra acid, so it drops.
    This also explains why DKA pts have increased RR:
    CO2 + H20 <--> H2CO3 <--> HCO3- + H+
    If you blow off extra CO2 (ie by upping RR) you shift the above equation to the left, and promote the formation of H2CO3 via CA, helping to mop up the H+.

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