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What Is Dka Protocol?

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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.....

How The Treatment Of Diabetic Ketoacidosis Has Improved

For patients with type 1 diabetes, one of the most serious medical emergencies is diabetic ketoacidosis (DKA). It can be life-threatening and, in most cases, is caused by a shortage of insulin. Glucose is the “fuel” which feeds human cells. Without it, these cells are forced to “burn” fatty acids in order to survive. This process leads to the production of acidic ketone bodies which can cause serious symptoms and complications such as passing out, confusion, vomiting, dehydration, coma, and, if not corrected in a timely manner, even death. High levels of ketones poison the body. DKA can be diagnosed with blood and urine tests and is distinguished from other ketoacidosis by the presence of high blood sugar levels. Typical treatment for DKA consists of using intravenous fluids to correct the dehydration, insulin dosing to suppress the production of ketones, and treatment for any underlying causes such as infections. Medical history notes that DKA was first diagnosed and described in 1886 and until insulin therapy was introduced in the 1920’s, this condition was almost universally fatal. However, with availability and advances in insulin therapy, the mortality rate is less t Continue reading >>

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  1. pamb

    My, but life is full of little challenges. Our latest is the observation that our bedroom, where my CFS husband spends 20 hrs/day or so, is just plain stinky.
    This post is mostly a curious one, wondering if anyone else has ever noticed this?
    We've washed everything, change sheets and his clothes very often and still a stinky bedroom. I've even moved everything and taken every drawer out so see if we had a dead mouse somewhere. nope.
    All I can conclude is that is it from dear husband's breath. It definitely smells like he has ketosis, something I'm familar with from our past competitive athletic days when serious over-training would lead your body to start living off itself, resulting in very weird breath. And for sure the stinky part would be compounded by the fact he is always cold, so has the heat cranked up and is always closing the door to keep the heat in. When he is not in the room we open the door and windows, even just a bit if it is cold, and wide open if warm. That helps a bit but not for long. If we had two bedrooms I'd rotate him day to day, but alas, just one.
    So, is it just us, or has anyone else noticed something similar? Of course, if so, any and all suggestions to alleviate are welcome.

  2. George

    After my CFS became active I noticed a distinct body oder change. I smelled 'sour', my sweat, breath, urine everything it seemed had gone sour on me. (grins) I was watching Rocky and Bullwinkel (long story) when I saw a short on using chlorophyll to get rid of onion breath. I remembered something about this from middle school chemistry so I looked it up on the web. Sure enough it's suppose to help with body odor. So I order some and I've been drinking a teaspoon in water twice a day for just over three months now.
    It has worked for me like a charm. Plus my digestive process seems to be working better as well. Now my house is back to just smelling like dogs. (big grins)

  3. richvank

    Ketosis in CFS
    pamb said: ↑
    My, but life is full of little challenges. Our latest is the observation that our bedroom, where my CFS husband spends 20 hrs/day or so, is just plain stinky.
    This post is mostly a curious one, wondering if anyone else has ever noticed this?
    We've washed everything, change sheets and his clothes very often and still a stinky bedroom. I've even moved everything and taken every drawer out so see if we had a dead mouse somewhere. nope.
    All I can conclude is that is it from dear husband's breath. It definitely smells like he has ketosis, something I'm familar with from our past competitive athletic days when serious over-training would lead your body to start living off itself, resulting in very weird breath. And for sure the stinky part would be compounded by the fact he is always cold, so has the heat cranked up and is always closing the door to keep the heat in. When he is not in the room we open the door and windows, even just a bit if it is cold, and wide open if warm. That helps a bit but not for long. If we had two bedrooms I'd rotate him day to day, but alas, just one.
    So, is it just us, or has anyone else noticed something similar? Of course, if so, any and all suggestions to alleviate are welcome.
    Hi, pamd.
    As far as I know, this degree of ketosis is unusual in CFS. Most PWCs have some elevation of beta hydroxybutyrate in their urine organic acids tests, but I don't think that having such severe ketosis that acetone is exhaled in significant quantities is very common in CFS. Maybe others will correct me if I am wrong about this.
    I do have some concern about your husband, because if ketosis becomes too severe, it results in ketoacidosis, which can be life-threatening. In this situation, the levels of the ketones become high enough in the blood to overcome the body's ability to buffer their acidity, so that the blood pH drops too low. I think it would be a good idea to have the pH of his blood measured. If it is too low, a doctor could help to raise it up. That would not stop the generation of ketones, but it would protect your husband.
    I would be very interested to see the results of a urine organic acids test on your husband. I see that Genova Diagnostics serves France through [email protected] Their urine organic acids test is called the Metabolic Analysis Profile.
    Generally speaking, ketosis occurs when acetyl-CoA rises high compared to normal in the cells.
    This is usually a result of the cells not being able to get enough glucose. The usual causes of ketosis are diabetes, starvation, a very high-fat ("ketogenic") diet, or prolonged, severe exercise, as you mentioned. When the cells do not get enough glucose, they cannot make oxaloacetate fast enough, and thus there is not enough of it to react with acetyl-CoA, so acetyl-CoA rises. It then reacts with itself to produce ketones.
    In your husband's case, I doubt that any of the usual causes of ketosis are present. I think that it is more likely that he has a severe block in his Krebs cycle, causing a very high rise in citrate, and that for some reason (perhaps genetic), his body is not able to divert the high citrate into the synthesis of fat. The result is back-pressure on the citrate synthase reaction, which would cause acetyl CoA to rise, thus generating ketones. I'm guessing that your husband does not gain weight. Is that correct?
    I think that most PWCs, who also have a Krebs cycle block, are able to divert citrate into making stored fat, and that prevents them from developing severe ketosis. It also causes them to tend to gain weight.
    The fact that your husband always feels cold is evidence of mitochondrial dysfunction (note that the Krebs cycle is located in the mitochondria, so a block in the Krebs cycle would be consistent with this).
    You asked for suggestions of how to alleviate this problem. Elsewhere on this forum I have posted about the Simplified Treatment Approach for lifting the partial methylation cycle block in CFS. When this treatment is successful (as in about two-thirds of the PWCs who have tried it) it allows glutathione to come up to normal, and that should eventually correct the problems in the mitochondria. If this worked in your husband's case, I think it would stop the ketosis. If you want to look into this further, you could go to this website: http://www.cfsresearch.org Click on M.E./CFS, and then on my name. As I've noted elsewhere, my position is that a person needs to be monitored by a physician while on this treatment. I also favor running the methylation pathways panel to determine whether there is a partial methylation cycle block before trying the treatment. This panel is offered by the Vitamin Diagnostics lab in the U.S. and by the European Laboratory of Nutrients in the Netherlands.
    I hope this is helpful.
    Best regards,
    Rich

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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 Emergencies, Diabetic Ketoacidosis In Adults, Part 3

Clinical Management Treatment consists of rehydration with intravenous fluids, the administration of insulin, and replacement of electrolytes. General medical care and close supervision by trained medical and nursing staff is of paramount importance in the management of patients with DKA. A treatment flowchart (Table 1.3) should be used and updated meticulously. A urine catheter is necessary if the patient is in coma or if no urine is passed in the first 4 hours…. Replacement of water deficit Patients with DKA have severe dehydration. The amount of fluid needing to be administered depends on the degree of dehydration (Table 1.4). Fluid replacement aims at correction of the volume deficit and not to restore serum osmolality to normal. Isotonic solution NaCl (0.9%) (normal saline; osmolality 308 mOsm/kg) should be administered even in patients with high serum osmolality since this solution is hypotonic compared to the extracellular fluid of the patient. 10 The initial rate of fluid administration depends on the degree of volume depletion and underlying cardiac and renal function. In a young adult with normal cardiac and/or renal function 1 L of normal saline is administered intrave Continue reading >>

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  1. [deleted]

    I'm not going to buy sticks or strips to pee on to tell me if I am in a state of ketosis or if there are ketones in my urine, however, I have a question
    For the first 7-10 days, I could (I believe) taste in my mouth when my body would go into ketosis. It's a fruity, almost metallic, something in between sort of taste.
    Sadly, I have no one I can breath on to sniff and tell me what it smells like to them to know if I managed to make it into ketosis. So my question is, what other means can I know if my body is properly dropping into Ketosis?
    I only ask because ever since my Meatza from 2 nights ago, I havn't tasted that familiar sensation a single time. And that worries me. I love this sort of diet because I get to just scarf down meat and cheese (and bacon!) like it's going out of style. TBH, I'm not even bothering to watch my total caloric intake yet, because I am simply watching my portion sizes and really acting as scared of carbs as I can be, and I'm hoping that takes makes the weight fall off. But I really like that taste in my mouth which I believe to be my body entering and maintaining a state of Ketosis, and am curious for anything else I might be able to tell from.
    Other than that, I am also beginning a fairly aggressive gym routine to coincide with the Keto, it will consists of 3 days of running, and 2-3 days of 'Muscle Failure'. The last time I was on a High Protein Low Carb diet it's what I did, and it worked out great before. It's also really simple to follow, 1 hour of running treadmill (or walking) on Mondays and Fridays, on Wednesday you do a 30 minute session. Then on Tuesday Thursday Saturday, you work the muscles. I started last night with the run (but since it was the first day I did the hour long session) and made it 4.11 miles on a treadmill, with a 1.0 incline to compensate for indoor running on a treadmill. My "goal" is to run 6 miles in an hour @ a 1.0 incline, without having to 'slow down' to a walk like I had to do numerous times yesterday. And then just build from there. As far as the muscle failure goes, I just want some muscle to look good in the mirror, and to look good for the ladies. I'm not going to kid myself, I'm doing this as much for myself as I am to bag a hottie. Plus being in shape and healthy is always a huge plus.
    So
    TL:DR ; besides distinct taste / breath, and peeing on sticks to look for ketones, are there any other solid signs of Ketosis?

  2. Targash

    simply consuming 20g or less net carbs a day ensures ketosis. some people can handle more but 20g seems to be the point of assurance.

  3. [deleted]

    That's my problem, I used as 'low carb' of a sauce as I had in my cupboards, so it was this weird off brand I must've bought at some 'cheap grocery store' like a Aldi's or something. It had a lot less sugar than the Hunt's in my cupboards. So for the meatza, I did only eat 1/4th of the entire meatza, but it still ... I don't know, I know nothing else I really eat through the day has any carbs in it. And then I made some Caveman Keto Chili last night, so more tomato sauce (couldn't find my paste) from the same can I had transferred to a fridge safe container, so more 'not a lot of sugar but definitely sugar in it' and that just worries me.
    Like today, I'll eat
    http://cavemanketo.com/chorizo-breakfast-casserole/
    This for both my breakfast and my lunch
    And tonight I'll eat
    http://cavemanketo.com/caveman-chili/
    So I'll hit 27 total carbs today, assuming I followed the recipes appropriately, but I'm not doing any amazing job of keeping the numbers solid. I pretty much use one entire green pepper to prepare these dishes, so for the breakfast dish it's one half of an onion , and one entire green pepper
    The same goes for the dinner dish, I use the OTHER half of the onion that was left over, and one more green pepper.

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Description Dextrose 5% in Water (D5W) raises total fluid volume it is also helpful in rehydrating and excretory purposes. Type of Solution Dextrose 5% Water Isotonic then hypotonic (once inside the body) Classification Isotonic then hypotonicD5LRS (Lactated Ringers Solution) IV Fluid Nonpyrogenic Parenteral fluid Electrolyte Nutrient replenisher Contents Dextrose Hydrous 50gm/L Mechanism of action Dextrose provides a source of calories. Dextrose is readily metabolized, may decrease losses of body protein and nitrogen, promotes glycogen deposition and decreases or prevents ketosis if sufficient doses are provided Indications Lactated Ringers and 5% Dextrose Injection, is indicated as a source of water, electrolytes and calories or as an alkalinizing agent. Contraindications solutions containing dextrose may be contraindicated in patients with known allergy to corn or corn products. Dose As directed by a physician. Dosage is dependent upon the age, weight and clinical condition of the patient as well as laboratory determinations. Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration whenever solution and container permit.

1. Start Iv Fluids (1 L Of 0.9% Nacl Per Hr Initially) 2. If Serum K+ Is <3.3 Meq/l Hold Insulin

DKA Diagnostic Criteria (See page 3 for more details):  Blood glucose >250 mg/dl,  Arterial pH <7.3,  Bicarbonate ≤18 mEq/l,  Anion Gap Acidosis  Moderate ketonuria or ketonemia.  Give 40 mEq/h until K ≥ 3.3 mEq/L 3. Initiate DKA Order Set Phase I 4. Start insulin 0.14 units/kg/hr IV infusion (calculate dose) RN will titrate per DKA protocol Insulin Potassium Bicarbonate IVF Look for the Cause - Insulin deficiency - Infection/Inflammation (PNA, UTI, pancreatitis, cholecystitis) - Ischemia/Infarction (myocardial, cerebral, gut) - Intoxication (EtOH, drugs) - Iatrogenic (drugs, lack of insulin) - Pregnancy DKA/HHS Pathway Phase 1 (Adult) Approved by Diabetes Steering Committee, MMC, 2015 Initiate and continue insulin gtt until serum glucose reaches 250 mg/dl. RN will titrate per protocol to achieve target. When sugar < 250 mg/dl proceed to DKA Phase II (reverse side) DKA/HHS Pathway Phase 2 (Adult) Non-ICU Patients Phase 2: Blood sugar now less than 250mgd/dl. If Anion Gap Normalized* If Anion Gap Elevated* Critical Illness (ICU) Follow guidelines to the right when gap has normalized.* Approved by Glycemic Steering Committee, MMC, Continue reading >>

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  1. David Channin

    Because common sense is not that common. All the time, well intentioned people call their docotr for emergencies, when they should call for an ambulance.

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