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Neurological Complications Of Dka

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Low-dose Vs Standard-dose Insulin In Pediatric Diabetic Ketoacidosisa Randomized Clinical Trial

Importance The standard recommended dose (0.1 U/kg per hour) of insulin in diabetic ketoacidosis (DKA) guidelines is not backed by strong clinical evidence. Physiologic dose-effect studies have found that even lower doses could adequately normalize ketonemia and acidosis. Lowering the insulin dose may be advantageous in the initial hours of therapy when a gradual decrease in glucose, electrolytes, and resultant osmolality is desired. Objective To compare the efficacy and safety of low-dose insulin against the standard dose in children with DKA. Design, Setting, and Participants This was a prospective, open-label randomized clinical trial conducted in the pediatric emergency department and intensive care unit of a tertiary care teaching hospital in northern India from November 1, 2011, through December 31, 2012. A total of 50 consecutive children 12 years or younger with a diagnosis of DKA were randomized to low-dose (n = 25) and standard-dose (n = 25) groups. Interventions Low-dose (0.05 U/kg per hour) vs standard-dose (0.1 U/kg per hour) insulin infusion. Main Outcomes and Measures The primary outcome was the rate of decrease in blood glucose until a level of 250 mg/dL or less is Continue reading >>

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  1. Alan Williamson

    I have been lifting weights, running, and biking. I lift just about every day. I have good muscle definition everywhere except my belly. I have about 10 pounds of fat around my belly and waist. How does a person get rid of that fat? It doesn't seem to want to go away.

    Cheers!

  2. devhammer

    Visceral fat isn't the fat around your waistline, it's the fat around your internal organs (aka viscera).
    Subcutaneous fat is different.

    Both can be reduced with keto, but there's no magic trick to burning fat from a particular part of your body. Just as it took time to put it on, it'll take time to take it off.

  3. Fiorella

    Intermittent fasting and extended fasting helps disintegrate visceral fat, too.

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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.....

Risk Factors For Cerebral Oedema In Children And Adolescents With Diabetic Ketoacidosis

Cerebral oedema (CO) is a rare life-threatening complication of diabetic ketoacidosis (DKA) in children. We analysed the biochemical and therapeutic risk factors for CO in DKA by a retrospective review of 256 children hospitalized for DKA between February 2003 and March 2015. The demographic characteristics, biochemical variables and therapeutic interventions were compared between the patients with and without CO. CO was observed in 22 (8.6%) of the 256 subjects included in the study. One of these patients (5%) had a fatal outcome and two patients (9%) survived with neurological consequences. CO was significantly associated with severe DKA: lower initial venous pH (p < 0.001) and bicarbonate (p < 0.001), higher initial blood glucose (p < 0.01), urea level (p < 0.05) and baseline serum osmolality (р < 0.05). During the treatment of DKA, low serum phosphate level was found to be significantly associated with CO (p < 0.05). We also found significant dependence between the development of CO and the initiation of treatment for DKA in another facility before hospitalization in our hospital (p < 0.05), bicarbonate application (p < 0.001), higher fluid volume infused initially (p < 0.01) Continue reading >>

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  1. kco143

    Keto without exercising?

    Hello everyone,
    Ever since I started the keto diet my fiance has decided he wants to try it too. The problem is that he never works out, except maybe every once in a while. Would keto dieting without exercise be a bad idea?

  2. sgfireman

    I think trying to transform your body or get slimmer without exercise is a bad idea in general. It's like trying to ride a bike with no wheels. You need the 3 keys: Diet, Weights, Cardio. Either he does it all the way or not at all.

  3. KLMARB

    Sure, its no problem. There is no requirement for exercise.

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In this video, Dr. Michael Agus discusses the risk factors, signs, symptoms, and treatment of cerebral edema in diabetic ketoacidosis. Please visit: www.openpediatrics.org OPENPediatrics is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: [email protected] Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause.

Risk Factors For Cerebral Edema In Children With Diabetic Ketoacidosis

Cerebral edema is an uncommon but devastating complication of diabetic ketoacidosis in children. Risk factors for this complication have not been clearly defined. In this multicenter study, we identified 61 children who had been hospitalized for diabetic ketoacidosis within a 15-year period and in whom cerebral edema had developed. Two additional groups of children with diabetic ketoacidosis but without cerebral edema were also identified: 181 randomly selected children and 174 children matched to those in the cerebral-edema group with respect to age at presentation, onset of diabetes (established vs. newly diagnosed disease), initial serum glucose concentration, and initial venous pH. Using logistic regression, we compared the three groups with respect to demographic characteristics and biochemical variables at presentation and compared the matched groups with respect to therapeutic interventions and changes in biochemical values during treatment. A comparison of the children in the cerebral-edema group with those in the random control group showed that cerebral edema was significantly associated with lower initial partial pressures of arterial carbon dioxide (relative risk of cer Continue reading >>

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  1. roshy

    DKA- what was your experience like?

    Hi all, i haven't been here for quite a while but its nice to see some of the same friendly faces!
    So i suffered with DKA back in october and havent felt healthy ever since. The hole experience left me very shaken up and traumatised! after spending 2 days in icu and a futher 3 days in hospital with drips and a urine cathador thigs completely regressed when i finially came home!! i was afraid to eat, i was afraid to leave the house, i didnt trust the meter, i would go extrememly low and and over react! i felt like my body was completely going to fail me. I promised myself i would never let something like that happen again however things are still out of control, im not taking my insulin out of pure lazyness and its basicaly routing now that i dont take the lantus, im not recording the sugar level and i really am falling into a hole which i feel like ill never be able to climb out of!
    The DKA experience was supposed to be a wake up call for me taking control, now its just something which i barely survived and left me confused about what kind of life im capable of living.
    After having type onefor 6 years i always believed controlling and accepting that my life would need to change would get easier, but instead my health is deteriorating as well as my optimism for life, and im only 22!!
    I was wondering what other experiences people may of had with DKA please share !! did you seek
    appropriate help support or advice which you may think might help myself and others??

  2. MAYS

    Welcome to Diabetic Connect !
    First and foremost, DKA is very serious and all diabetics should know the signs and symptoms of such because although it can happen to type 1 diabetics, it also happens to type 2 diabetics.
    You must be very careful and both monitor and manage your glucose level and take your insulin when and in the necessary dosage, here is some information :
    What is diabetic ketoacidosis (DKA) ?
    Diabetic ketoacidosis (DKA) is a life-threatening condition that develops when cells in the body are unable to get the sugar (glucose) they need for energy, such as when you have diabetes and do not take enough insulin. Without insulin, the body cannot use sugar for energy. When the cells do not receive sugar, the body begins to break down fat and muscle for energy. When this happens, ketones, or fatty acids, are produced and enter the bloodstream, causing the chemical imbalance (metabolic acidosis) called diabetic ketoacidosis.
    What causes DKA ?
    Ketoacidosis can be caused by not taking enough insulin, having a severe infection or other illness, becoming severely dehydrated, or some combination of these factors. It can occur in people who have little or no insulin in their bodies (mostly people with type 1 diabetes, but it can happen with type 2 diabetes) when their blood sugar levels are high.
    What are the symptoms ?
    Your blood sugar may be quite high before you notice symptoms, which include:
    Flushed, hot, dry skin.
    Blurred vision.
    Feeling thirsty.
    Drowsiness or difficulty waking up. Young children may lack interest in their normal activities.
    Rapid, deep breathing.
    A strong, fruity breath odor.
    Loss of appetite, abdominal pain, and vomiting.
    Confusion.
    When diabetic ketoacidosis is severe, you may have difficulty breathing, your brain may swell (cerebral edema), and there is a risk of coma and even death.
    http://diabetes.webmd.com/tc/diabetic-ketoaci...

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