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Pediatric Dka Guidelines 2016

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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.....

Pediatric Diabetic Ketoacidosis Emergency Department Care

Pediatric Diabetic Ketoacidosis Emergency Department Care Author: Grace M Young, MD; Chief Editor: Stephen Kemp, MD, PhD more... Diabetic ketoacidosis (DKA) is a complex metabolic state of hyperglycemia, ketosis, and acidosis. [ 1 , 2 ] Diabetic ketoacidosis results from untreated absolute or relative deficiency of insulin in type 1 or type 2 diabetes mellitus , respectively. Hyperglycemia results from impaired glucose uptake because of insulin deficiency and excess glucagon with resultant gluconeogenesis and glycogenolysis. Glucagon excess also increases lipolysis with the formation of ketoacids. Ketone bodies provide alternative usable energy sources in the absence of intracellular glucose. The ketoacids (acetoacetate, beta-hydroxybutyrate, acetone) are products of proteolysis and lipolysis. Hyperglycemia causes an osmotic diuresis that leads to excessive loss of free water and electrolytes. Resultant hypovolemia leads to tissue hypoperfusion and lactic acidosis . Ketosis and lactic acidosis produce a metabolic acidosis; however, supplemental bicarbonate is not recommended. Acidosis usually resolves with isotonic fluid volume replenishment and insulin therapy. [ 3 ] A pediatric Continue reading >>

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  1. humbled

    I present to you here a bunch of information I have assimilated/catalogued on this subject.
    The ketogenic diet is an effective weight loss tool, but it does not guarantee that you will move from fat to thin without complications. It simply allows your body to regulate its fat cells better, and should your body choose a destination that is fatter than you like, you may find yourself stuck there. This then becomes the homeostatic weight that your body prefers to maintain, for whatever reason.
    Possible Scientific Mechanisms for Plateau
    G - Glucose tolerance: when we initially put on our weight, we likely did so in an environment of chronically elevated blood sugar. We are all likely to have a problem with our glucose tolerance, thanks to the standard grain-focused, carbohydrate-laden diet. There are two aspects to this issue. First is the glucose sensitivity of cells. We need our cells to be eager to use blood glucose when it is available, rather than rely heavily on insulin to force it. The other side of the coin is in the pancreas, in how much insulin we secrete when carbohydrates pass through the upper GI tract, or when we think about eating sweet food or place sweet food on the tongue (artificial sweeteners included). These problems can be described as insulin resistance, insulin sensitivity, insulin oversecretion, etc. We may reach a homeostatic weight, even with small amounts of carbohydrate in the diet, due to the various ways in which our glucose tolerance may be impaired.
    V - Visceral fat: insulin-driven fat storage seems to deposit fat more in the abdomen than in other locations. This is the so called apple/pear body shape talk you may have heard. Interestingly, visceral fat is more hormonally active than other types of fat and may resist collection, even when the metabolism has been restored to normal function via the cessation of carbohydrate intake. These fat cells secrete hormones called adipokines that interfere with proper glucose tolerance. They are the zombie fat cells that want to eat the brains of your properly-functioning metabolism.
    O - Overnutrition: there are some who say that eating too many calories will cause a plateau. Here is a sample from Dr. Eades' blog on the subject. I believe this hypothesis, but it may not happen as frequently as one would expect. Lowering calories may lower carbohydrate intake. If one oversecretes insulin, even a slight lowering of carbs will aid metabolic regulation and may set the homeostatic point back some amount. But for the cases where our metabolism is healthy and we are overeating, the body will likely not dip too deeply into any of its fat stores. Another form of overnutrition may be an overconsumption of protein. Again, if we have problems with glucose tolerance, the protein may tap into those issues as our body converts it to glucose.
    K - Keto adaptation: your body will gradually use ketones more efficiently (see some comments here). There may even come a time when you cannot make your ketostix turn purple at all. This is not a bad thing and it does not mean you cannot lose weight, or that the health advantages of low-carb are gone. The Inuit thrive on this diet their whole lives, after all. It means that you may have to watch calories a little more closely than in the years prior, although it should still be extremely difficult to gain fat.
    L - Leptin signaling: fat is hormonally active. It sends out leptin, a satiety hormone whose job is to say "hey, come eat me." As you lose non-visceral fat, there will be less fat cells around sending this signal to your metabolism. This is one possible answer to the tapering off of weight loss (on any diet, in fact). I sincerely hope it isn't the case, but some obesetologists theorize that being obese for the long term can permanently burn out leptin receptors. And to add to your misery, insulin interferes with leptin reception - but that is something keto helps solve.
    C - Carb creep, cheating, and other "user error": we get comfortable with our diets and experiment with expanding our palate. We lose some of the rigor that we applied when starting. The end result is that we are eating more carbohydrate than we expect.
    What to Do About It
    Before you take action to fight your plateau, make sure you are actually stuck. Don't rely on your scale alone; use body tape, calipers, a tight pair of paints, number of belt loops, or whatever tools you might have where you can verify that nothing is changing. There are times on keto where you may drop a size without losing weight. Now that we have that out of the way, you may have noticed the individual letters prefixed to the mechanisms above. I will use those letters to indicate how the methods and mechanisms are related.
    When you undertake any action, test it for a fixed period (2-4 weeks) to see if it is effectual, and if not, you needn't bother yourself with integrating it into your lifestyle. You may be able to try some of this occasionally to kickstart the weight loss process, which will then go again even if you discontinue the behavior. Some of these tools can be used as an ongoing adjunct to keto.
    (G) Employ an endurance exercise program. I personally recommend HIIT (or SIT, in this study), but it seems that any sort of endurance training improves glucose tolerance. It's not about burning calories.
    (G,V) Give intermittent fasting a shot, either a gentle 16/8 schedule, or even up to a more aggressive ADF (alternate day feeding) schedule. This is not necessarily a means of calorie restriction, since some IF practitioners call for completely making up for the missed meal period. Hence, this is a way of redistributing your calories in your schedule such that you are relying on fat reserves more often.
    (G,O) Eat a nearly zero-carb diet that is 90% fat, and optionally restrict yourself to little more than 1,000 calories per day. (Atkins called this "The Fat Fast.")
    (C) Make sure carb counts are correct and that you're attaining your goals.
    (O,C,K) Reduce caloric intake. (Last resort IMO.)
    (G,V,L) Wait. It takes a number of years for all the cells in your body to replace themselves. The cells that grow while on the ketogenic diet will hopefully be more insulin sensitive than your old cells, and over time your homeostatic weight may drop.
    (C) Oy! Don't do that.
    I think that's everything for now. I will update this to reflect quality tidbits that anyone wants to contribute.
    Update 1: fix some wording.
    Update 2: reword end of leptin section.

  2. lessofme

    Tons of useful stuff here, thanks. But this:
    It's not about burning calories.
    ... is the theme of the year for me. Uncoupling exercise from the impulse to ask, "how many calories did I just burn during that workout?" was a huge revelation, and has done more to facilitate improving my fitness than anything else I've done. Realizing that the number of calories I'd burned on a given hike or bike ride or strength workout was basically irrelevant; and that the point was to change how my body functions and how I live in it, made a world of difference to me, both practically and psychologically. Somehow shifting my motivation from, "I have to do this to meet my calorie goal for the day," to "I do this because I like how I feel when I'm doing it" changed everything. Now I exercise far more than I ever did before, enjoy doing it, and am actively looking forward to the day when I can do bigger, more intense, more fun things.
    Also, as far as plateaus and women are concerned, I can't overstate how annoying hormones can be in mimicking a plateau. I've come to learn that there's very little point in getting worried about a two- or three-week stall in weight or volume loss, because my month invariably goes like this:
    week 1: lose a pound
    week 2: maybe lose another pound, maybe nothing (also, may or may not appear to drop out of ketosis in spite of not eating any differently)
    week 3: nada; spend the week fighting the Bolshevik Army*
    week 4: ZOMG lose like nine fucking pounds and two inches off my hip
    In my experience, more than half of the women I've met complaining about a perceived plateau are within a week of starting their periods.
    tl;dr: it's really not about burning calories; also, water retention is a pain in the ass.
    *I love a good communist-themed euphemism for menstruation.

  3. [deleted]

    This is my new favorite euphemism. Thank you.

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What is KETOACIDOSIS? What does KETOACIDOSIS mean? KETOACIDOSIS meaning - KETOACIDOSIS definition - 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... Ketoacidosis is a metabolic state associated with high concentrations of ketone bodies, formed by the breakdown of fatty acids and the deamination of amino acids. The two common ketones produced in humans are acetoacetic acid and ß-hydroxybutyrate. Ketoacidosis is a pathological metabolic state marked by extreme and uncontrolled ketosis. In ketoacidosis, the body fails to adequately regulate ketone production causing such a severe accumulation of keto acids that the pH of the blood is substantially decreased. In extreme cases ketoacidosis can be fatal. Ketoacidosis is most common in untreated type 1 diabetes mellitus, when the liver breaks down fat and proteins in response to a perceived need for respiratory substrate. Prolonged alcoholism may lead to alcoholic ketoacidosis. Ketoacidosis can be smelled on a person's breath. This is due to acetone, a direct by-product of the spontaneous decomposition of acetoacetic acid. It is often described as smelling like fruit or nail polish remover. Ketosis may also smell, but the odor is usually more subtle due to lower concentrations of acetone. Treatment consists most simply of correcting blood sugar and insulin levels, which will halt ketone production. If the severity of the case warrants more aggressive measures, intravenous sodium bicarbonate infusion can be given to raise blood pH back to an acceptable range. However, serious caution must be exercised with IV sodium bicarbonate to avoid the risk of equally life-threatening hypernatremia. Three common causes of ketoacidosis are alcohol, starvation, and diabetes, resulting in alcoholic ketoacidosis, starvation ketoacidosis, and diabetic ketoacidosis respectively. In diabetic ketoacidosis, a high concentration of ketone bodies is usually accompanied by insulin deficiency, hyperglycemia, and dehydration. Particularly in type 1 diabetics the lack of insulin in the bloodstream prevents glucose absorption, thereby inhibiting the production of oxaloacetate (a crucial molecule for processing Acetyl-CoA, the product of beta-oxidation of fatty acids, in the Krebs cycle) through reduced levels of pyruvate (a byproduct of glycolysis), and can cause unchecked ketone body production (through fatty acid metabolism) potentially leading to dangerous glucose and ketone levels in the blood. Hyperglycemia results in glucose overloading the kidneys and spilling into the urine (transport maximum for glucose is exceeded). Dehydration results following the osmotic movement of water into urine (Osmotic diuresis), exacerbating the acidosis. In alcoholic ketoacidosis, alcohol causes dehydration and blocks the first step of gluconeogenesis by depleting oxaloacetate. The body is unable to synthesize enough glucose to meet its needs, thus creating an energy crisis resulting in fatty acid metabolism, and ketone body formation.

Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes mellitus.[1] Signs and symptoms may include vomiting, abdominal pain, deep gasping breathing, increased urination, weakness, confusion, and occasionally loss of consciousness.[1] A person's breath may develop a specific smell.[1] Onset of symptoms is usually rapid.[1] In some cases people may not realize they previously had diabetes.[1] DKA happens most often in those with type 1 diabetes, but can also occur in those with other types of diabetes under certain circumstances.[1] Triggers may include infection, not taking insulin correctly, stroke, and certain medications such as steroids.[1] DKA results from a shortage of insulin; in response the body switches to burning fatty acids which produces acidic ketone bodies.[3] DKA is typically diagnosed when testing finds high blood sugar, low blood pH, and ketoacids in either the blood or urine.[1] The primary treatment of DKA is with intravenous fluids and insulin.[1] Depending on the severity, insulin may be given intravenously or by injection under the skin.[3] Usually potassium is also needed to prevent the development of low blood potassium.[1] Th Continue reading >>

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  1. ANIMALISTIKZ

    Colors of KetoStix

    Hey guys ive been eating a keto diet for about a week and a couple days since my last carb up. I finally got ketostix and i used it today and i only got small amounts(1.5 mmol/l) should i be aiming ideally for something? Or is anything thats not negative efficient? I drink lots of water by the way, so im sure that has a factor on how high my concentration of ketones is. Thanks

  2. jrock1784

    Originally Posted by TheLINN
    Hey guys ive been eating a keto diet for about a week and a couple days since my last carb up. I finally got ketostix and i used it today and i only got small amounts(1.5 mmol/l) should i be aiming ideally for something? Or is anything thats not negative efficient? I drink lots of water by the way, so im sure that has a factor on how high my concentration of ketones is. Thanks

    Any trace coloring on the sticks is fine...if you are in ketosis you are in ketosis....the darker shades just mean you either arent very hydrated or your body is not burning all your ketones for fuel and has alot excess....you dont even really have to test positive on those things to be in ketosis b/c technically you could be using all your ketones for energy
    I wouldnt rely on them very much after you get used to how your body feels in ketosis

  3. ANIMALISTIKZ

    Originally Posted by jrock1784
    Any trace coloring on the sticks is fine...if you are in ketosis you are in ketosis....the darker shades just mean you either arent very hydrated or your body is not burning all your ketones for fuel and has alot excess....you dont even really have to test positive on those things to be in ketosis b/c technically you could be using all your ketones for energy
    I wouldnt rely on them very much after you get used to how your body feels in ketosis


    Yeah, i cant really tell im in ketosis physically by symptoms, i never have energy, i dont have anemia or anything not sure, i think a sleeping disorder, i definitely have metallic taste and drink alot of water though.

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Acute Management Of Pediatric Diabetic Ketoacidosis

Acute Management of Pediatric Diabetic Ketoacidosis To view all publication components, extract (i.e., unzip) them from the downloaded .zip file. Editor's Note: This publication predates our implementation of the Educational Summary Report in 2016 and thus displays a different format than newer publications. Introduction: This educational tool is a PowerPoint presentation that allows providers to quickly access guidelines for acute management of pediatric diabetic ketoacidosis (DKA). It was created after a chart review of pediatric patients with DKA determined that guidelines of DKA management were being incompletely followed. Methods: The resource contains recommendations from the American Diabetes Association guidelines, as well as a learning module consisting of a case scenario and three questions, each of which highlights important aspects of the care of pediatric patients with DKA.Session length should be no longer than 15 minutes. Results: Data are currently being collected on the reach of this educational tool. Discussion: The resource is limited by its short duration. It was deliberately designed to be readily accessible in a time-limited situation for initial care. Part o Continue reading >>

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  1. bookstorecowboy

    I have read a lot of posts and web sites about ketosis and about "weight loss," and I've read some books, as well. Based on what I've read, it seems that it would be impossible to "burn fat" (in the sense of burning body fat) without entering ketosis. If I have this right, the body burns energy supplies in these stages:
    1) alcohol (e.g. most of what is in beer)
    2) blood sugars (e.g. table sugar, most of the stuff grains break down into, fruit sugars, etc.)
    3) glycogen (stored in muscles)
    4) fat (fats that are eaten come first, followed by body fat)
    5) protein (comes last, after depletion of all other easily available stores of energy)
    It would seem logical, if this is right, that as long as your body has stores of alcohol, blood sugars, and glycogen, no body fat will be burned.
    So, to go on, if I have this right, then regardless of the kind of diet you are on, the only way to lose "weight" (in the sense of losing fat, which is the only kind of weight loss 99% of us are interested in) is to enter ketosis.
    Finally, if this is right, then any diet that promises "weight loss" (be it Ornish, the Paleo Diet, Atkins, or whatever) is promising that you will enter ketosis. If not, you will not actually "lose weight" in any sense you could desire. And it follows from this that any diet that works to any degree has no business warning people off ketosis, since it is going to occur.
    It also follows from this, in general although perhaps not in every situation, that the fewer carbs you eat, the more body fat you will burn (as long as you are in a calorie deficit).
    Is this right or wrong? Or right in some ways, but wrong in others?
    Thank you, list members...
    By the way, I bring this up in part because I have read quite a few critiques of Atkins, Paleo, and all "low carb diets," and every single one of them seems to screech about the supposed dangers of ketosis. I remember reading this back in the 1980s: "the one thing you don't want to do is enter ketosis, because then your body will be in starvation mode and will start hoarding ever single calorie," blah, blah, blah.

  2. ciep

    I don't know that I can provide a clear and/or complete answer to that question -- so I'll leave it to others. I would like to point out though that your body usually burns a mixture of fuels. So when both glucose and circulating fats are available (as they usually are) your body doesn't use the glucose exclusively (only moving on to the fats when no further glucose is available). Instead, it uses both simultaneously.
    I hope that helps. Basically, I guess I'm trying to say that you are always "burning fat". The key to weightloss is getting your body into a state where you're burning more of it than you're storing (on average). Reducing carbohydrates tends to help many people achieve this (and certainly an excess of carbs can make it difficult or even impossible), but I don't think ketosis necessarily required (depending on one's metabolism). In the past, I've successfully "cut up" with carbs in the 350g/day range.

  3. PokeyBug

    My ex-husband certainly lost fat without being in ketosis. He lost about 30 pounds on a low fat diet and exercise just before we met. He was miserable and hungry the entire time, but he thought CW was the only way to go. I somehow doubt he was in ketosis eating pasta every other night.

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