What Causes The Fluid And Electrolyte Disturbances In Dka?

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Fluid And Electrolyte/acid-base Flashcards

1. 50 year old with pneumonia, diaphoresis and a high fever Rationale: Diaphoresis and high fever can lead to free water loss through the skin, resulting in hypernatremia. Loop diuretics are more likely to result in a hypovolemic hyponatremia. Diarrhea and vomitting cause both sodium and water losses. Clients with SIADH have hyponatremia due to increased water reabsorption in the renal tubules. A client is admitted with diabetic ketoacidosis and, with treatment, has a normal blood glucose, pH, and serum osmolality. During assessment, the client complains of weakness in the legs. Which of the following is a priority nursing intervention? 1. Request a physical therapy consult from the physician. 2. Ensure the client is safe from falls and check the most recent potassium level. 3. Allow uninterrupted rest periods throughout the day. 4. Encourage the client to increase intake of dairy products and green leafy vegetables. 2. Ensure the client is safe from falls and check the most recent potassium level. Rationale: In the treatment of diabetic ketoacidosis the blood sugar is lowered, the pH is corrected, and potassium moves back into the cells, resulting in low serum potassium. Client s Continue reading >>

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  1. stardustshadow

    So, long story short, I got an infected gland under my arm and had to have it surgically removed (ow!). Because these things often are staph infections, the surgeon prescribed me antibiotics.
    It was that time of the month, so I was already really swollen up with water weight.
    Well, the antibiotics kicked me totally out of ketosis and now I am *sigh* struggling to get back in and FINALLY get rid of the water weight, which did NOT go away after my period.
    I am on another antibiotic, since I had an allergic reaction to the first one.
    One day left! I can't wait to be finished!
    Has anyone else had this happen? Did the weight go away? I fought to lose these pounds and I am sad that they seem to have come back literally overnight!

  2. Leo41

    For many people (I am one of them), the body tends to retain a lot of water during illness or infection. It's part of the immune system response. My body dumps the water as soon as I'm well again. It can be a significant number on the scale, as water weighs more than fat.

  3. stardustshadow

    That may have something to do with it...the thing is, I have had the infection for months, just had it removed last week! But yes, it IS a significant amount. But I can also tell that it is water...my electronic 'body fat monitor' shows no change in body fat % and my hands are all swollen. But seriously, I am getting tired of it now!
    Something certainly did knock me out of ketosis. I don't know if it was the antibiotics or the antihistames I had to take for the allergic reaction, but something sure did and I didn't eat any differently!

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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.

Diabetic Ketoacidosis And Cerebral Edema

Elliot J. Krane, M.D. Departments of Pediatrics and Anesthesiology Stanford University Medical Center Introduction In 1922 Banting and Best introduced insulin into clinical practice. A decade later the first reported case of cerebral edema complicating diabetic ketoacidosis (DKA) was reported by Dillon, Riggs and Dyer writing in the pathology literature. While the syndrome of cerebral edema complicating DKA was either not seen, ignored, or was unrecognized by the medical community until 3 decades later when the complication was again reported by Young and Bradley at the Joslin Clinic, there has since been a flurry of case reports in the 1960's and 1970's and basic and clinical research from the 1970's to the 1990's leading to our present day acceptance of this as a known complication of DKA, or of the management of DKA. In fact, we now recognize that the cerebral complications of DKA (including much less frequent cerebral arterial infarctions, venous sinus thrombosis, and central nervous system infections) are the most common cause of diabetic-related death of young diabetic patients (1), accounting for 31% of deaths associated with DKA and 20% of all diabetic deaths, having surpas Continue reading >>

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  1. FaintIlluzion

    I know on Keto you want to have more fat then protein, but how will too much protein occasionally effect weight loss? Will it kick me off track of loosing weight? What are the negatives of getting more protein then fats in a day?

  2. thadass

    Ratios don't matter; you have no need to compare the macro-nutrients. Evaluate each macro individually.
    There is no harm at all in having more protein than fat, but there is a possible risk from having WAY too much protein. Having even a little more protein than you really need is also simply a waste of protein.
    Enter your info in the keto calculator in the side bar and:
    Stay under your net carb limit (<20g is best)
    Meet your protein goal every day
    Eat fats to satiate hunger and fill out your caloric intake (do not have too high of a caloric deficit. 20% is best for most).

  3. dernnn

    Just curious, why can't you have too high of a deficit? The keto calculator puts me at 1700 for 20% deficit, and I find it a struggle to get to about 1200 calories. (On keto for a week FWIW)

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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.....

Diabetic Ketoacidosis

OVERVIEW potentially life-threatening complication of diabetes melitus resulting from the consequences of insulin deficiency Diagnostic criteria pH < 7.3 ketosis (ketonemia or ketonuria) HCO3 <15 mmol/L due to high anion gap metabolic acidosis (HAGMA) hyperglycemia (may be mild; euglycemic DKA can occur) PATHOGENESIS increased glucagon, cortisol, catcholamines, GH decreased insulin -> hyperglycaemia -> hyperosmolality + glycosuria -> electrolyte loss -> ketone production from metabolism of TG -> acidosis HISTORY dry, abdominal pain, polyuria, weight loss, coma risk factors: non-compliance, illness, newly diagnosed ROS to rule find out possible precipitant (infection, MI, pneumonia, GI illness) normal insulin regime diabetic control previous DKA’s/admissions previous ICU admissions EXAMINATION volume assessment signs of cause e.g. (infection) GCS work of breathing INVESTIGATIONS ABG electrolytes osmolality urinalysis: ketones pregnancy test standard investigations to rule out cause: FBC, ECG, CXR MANAGEMENT Goals (1) establish precipitant and treat (2) assess severity of metabolic derangement (3) cautious fluid resuscitation with replacement of body H2O (4) provision of insulin (5 Continue reading >>

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  1. jpg391

    Why Does Diabetes Make You So Thirsty?
    By Sanjay Gupta, MD
    [Why-does-diabetes-make-me-so-thirsty] Excessive thirst, or polydipsia, can be triggered by different factors such as eating too much salt or taking medications that cause dry mouth. Thirst is also a symptom of diabetes. For people with diabetes, thirst can be a sign of hyperglycemia, or high blood sugar.
    The kidneys play a vital role in regulating levels of blood sugar by filtering the blood and absorbing excess glucose. When very high levels of sugar build up in the blood, the kidneys can’t keep up and they produce more urine than normal — a condition known as polyuria. As a result, you can become dehydrated.
    “People who have well-controlled diabetes should be at no increased risk for excessive thirst compared with somebody who doesn’t have diabetes,” says Noah Bloomgarden, MD, assistant professor of medicine-endocrinology at the Albert Einstein College of Medicine and clinical endocrinologist in the division of endocrinology, diabetes, and metabolism at the Montefiore Health System in the Bronx, New York. “It’s really poor control of one’s blood sugar and an increase in urination and excretion of water that makes people [with diabetes] feel very thirsty and increases their need to maintain water balance.”
    As Dr. Bloomgarden points out, even people who are doing a good job of controlling their diabetes can develop very high blood sugar. A cold, infection, or even a very stressful situation can cause blood sugar to rise, and excessive thirst may be the first sign that something is wrong. “If you’re experiencing excessive thirst, you should contact your doctor immediately, because it may indicate severe hyperglycemia,” says Bloomgarden.
    If you have diabetes and you’re not sure whether you’re unusually thirsty, Bloomgarden suggests that you check your blood sugar. If your blood sugar is normal but you’re thirstier than usual (or you’re going to the bathroom more often), consult your doctor.
    If you are experiencing excessive thirst related to hyperglycemia, it’s imperative to get your diabetes under control. Make sure you’re following the treatment plan prescribed by your doctor, including any lifestyle recommendations such as eating a healthy diet and exercising regularly. If you’re having trouble sticking with your treatment plan, you may benefit from consulting with a certified diabetes educator, who can help you self-manage your blood sugar.
    It’s also important to make sure you’re drinking enough water, especially if your blood sugar is elevated. The Joslin Diabetes Center recommends drinking a minimum of eight glasses of water a day.
    “There are no complications associated with increased thirst if people are able to drink water freely,” says Bloomgarden. But it can become a major issue if somebody is elderly or isn’t mobile and doesn’t have the ability to access water or other liquids. “Then they can get profoundly dehydrated, and that can be extremely dangerous,” he warns.
    Updated: 10/17/2016
    Source http://www.everydayhealth.com/columns/paging-dr-gupta/why-does-diabetes-make-you-so-thirsty/?pos=4&xid=nl_EverydayHealthManagingDiabetes_20161104

  2. t1wayne

    James - not sure your motivation in posting this, but just a few observations.
    First, this summary applies to ONLY Diabetes Mellitus (DM)... NOT Diabetes Insipidus (DI). (Authors who simply use the term "diabetes" annoy me). AND... it applies to BOTH forms of DM - T1 and T2. Here's a little summation (a single paragraph from a longer summation) from the NIH:
    "Diabetes insipidus and diabetes mellitus—which includes both type 1 and type 2 diabetes—are unrelated, although both conditions {DM and DI} cause frequent urination and constant thirst. Diabetes mellitus causes high blood glucose, or blood sugar, resulting from the body's inability to use blood glucose for energy. People with diabetes insipidus have normal blood glucose levels; however, their kidneys cannot balance fluid in the body."
    (Emphasis mine); {Bracketed insert mine}
    So... frequent urination and thirst are symptoms of both DM and DI... and it applies to both forms of DM, and for the same reasons.
    Last note to the folks that review these posts... I refer to "both" forms of DM because ALL forms, including the "other" forms, are biochemically caused by one of two things - Insulin resistance (T2, gestational and MODY) or Autoimmune destruction of the pancreatic beta cells (T1, LADA).
    Here's the link to the NIH article on DI: https://www.niddk.nih.gov/health-information/health-topics/kidney-disease/diabetes-insipidus/Pages/facts.aspx

  3. maryd98

    My understanding has always been that if your BG is so high that you're urinating frequently, you become dehydrated and thus you get super-thirsty, and then it just becomes a vicious cycle.
    Maybe that's just 'cause these were two symptoms I had when I was diagnosed, but I haven't heard of diabetes (in general) making you so thirsty....but then I looked at James' post again.
    This is (sort of) in the article James quoted, though it kind of got buried, IMO. I had to read through it twice to catch it:
    "When very high levels of sugar build up in the blood, the kidneys can’t keep up and they produce more urine than normal — a condition known as polyuria. As a result, you can become dehydrated."
    This is followed (agian, in James' quote of the article) by....
    “People who have well-controlled diabetes should be at no increased risk for excessive thirst compared with somebody who doesn’t have diabetes,” says Noah Bloomgarden, MD, assistant professor of medicine-endocrinology at the Albert Einstein College of Medicine and clinical endocrinologist in the division of endocrinology, diabetes, and metabolism at the Montefiore Health System in the Bronx, New York. “It’s really poor control of one’s blood sugar and an increase in urination and excretion of water that makes people [with diabetes] feel very thirsty and increases their need to maintain water balance.”

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