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What Is Ketoacidosis Wiki

Diabetic Ketoacidosis (dka)

Diabetic Ketoacidosis (dka)

Also see Pet Diabetes Wiki: Ketoacidosis A Ketone Primer by an FDMB user What are Ketones? Ketones or ketone bodies (acetone, acetoacetic acid, and beta-hydroxybutyric acid) are waste products of fatty acid breakdown in the body. This is the result of burning fat, rather than glucose, to fuel the body. The body tries to dispose of excess ketones as quickly as possible when they are present in the blood. The kidneys filter out ketones and excrete them into the urine. Should you care about ketones? YES! If they build up, they can lead to very serious energy problems in the body, resulting in diabetic ketoacidosis, a true medical emergency. If the condition is not reversed and other systemic stresses are present, ketones may continue to rise and a condition known as diabetic ketoacidosis (DKA) may occur. This condition can progress very quickly and cause severe illness. It is potentially fatal even when treated. Recognition of DKA and rapid treatment by your veterinarian can save your cat's life. Signs of Diabetic Ketoacidosis (DKA) Drinking excessive amounts of water OR no water Excessive urination Diminished activity Not eating for over 12 hours Vomiting Lethargy and depression Weakness Breathing very fast Dehydration Ketone odor on breath (smells like nail-polish remover or fruit) Causes of Diabetic Ketoacidosis (DKA) Insulin dependent diabetes mellitus Inadequate insulin dosing or production Infection Concurrent diseas that stresses the animal Estrus Medication noncompliance Lethargy and depression Stress Surgery Idiopathic (unknown causes) Risk Factors for DKA Any condition that causes an insulin deficiency History of corticosteroid or beta-blocker administration Diagnosis Laboratory tests performed by your vet are necessary for diagnosis. Depending on how sick your c Continue reading >>

Diabetic Coma

Diabetic Coma

Diabetic coma is a reversible form of coma found in people with diabetes mellitus. It is a medical emergency.[1] Three different types of diabetic coma are identified: Severe low blood sugar in a diabetic person Diabetic ketoacidosis (usually type 1) advanced enough to result in unconsciousness from a combination of a severely increased blood sugar level, dehydration and shock, and exhaustion Hyperosmolar nonketotic coma (usually type 2) in which an extremely high blood sugar level and dehydration alone are sufficient to cause unconsciousness. In most medical contexts, the term diabetic coma refers to the diagnostical dilemma posed when a physician is confronted with an unconscious patient about whom nothing is known except that they have diabetes. An example might be a physician working in an emergency department who receives an unconscious patient wearing a medical identification tag saying DIABETIC. Paramedics may be called to rescue an unconscious person by friends who identify them as diabetic. Brief descriptions of the three major conditions are followed by a discussion of the diagnostic process used to distinguish among them, as well as a few other conditions which must be considered. An estimated 2 to 15 percent of diabetics will suffer from at least one episode of diabetic coma in their lifetimes as a result of severe hypoglycemia. Types[edit] Severe hypoglycemia[edit] People with type 1 diabetes mellitus who must take insulin in full replacement doses are most vulnerable to episodes of hypoglycemia. It is usually mild enough to reverse by eating or drinking carbohydrates, but blood glucose occasionally can fall fast enough and low enough to produce unconsciousness before hypoglycemia can be recognized and reversed. Hypoglycemia can be severe enough to cause un Continue reading >>

Talk:diabetic Ketoacidosis

Talk:diabetic Ketoacidosis

Diabetic ketoacidosis has been listed as one of the Natural sciences good articles under the good article criteria. If you can improve it further, please do so. If it no longer meets these criteria, you can reassess it. August 4, 2009 Good article nominee Listed Ideal sources for Wikipedia's health content are defined in the guideline Wikipedia:Identifying reliable sources (medicine) and are typically review articles. Here are links to possibly useful sources of information about Diabetic ketoacidosis. PubMed provides review articles from the past five years (limit to free review articles or to systematic reviews) The TRIP database provides clinical publications about evidence-based medicine. Other potential sources include: Centre for Reviews and Dissemination and CDC WikiProject Medicine [hide](Rated GA-class, Mid-importance) This article is within the scope of WikiProject Medicine, which recommends that medicine-related articles follow the Manual of Style for medicine-related articles and that biomedical information in any article use high-quality medical sources. Please visit the project page for details or ask questions at Wikipedia talk:WikiProject Medicine. GA This article has been rated as GA-Class on the project's quality scale. Mid This article has been rated as Mid-importance on the project's importance scale. Comment[edit] The section "Ketone body production" is very poor; it needs rewritten. Ketones needn't be desribed as "fuel for the brain" - they are used in the production of acetyl-CoA. —Preceding unsigned comment added by Dermotmallon (talk • contribs) 10:54, 10 June 2008 (UTC) more re ketone bodies[edit] The mechanism section does not clearly explain the pathophysiology of DKA. I am not an expert, but I believe the release of acidifying ketone bod Continue reading >>

Ketoacidosis

Ketoacidosis

Ketoacidosis Classification and external resources Specialty Endocrinology DiseasesDB 29670 eMedicine med/102 [edit on Wikidata] 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 β-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.[1] 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.[2] Ketosis may also give off an odor, 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 dia Continue reading >>

Diabetic Ketoacidosis (dka)

Diabetic Ketoacidosis (dka)

take bloods for FBE, U&E, blood gas, ketones, glucose, osmolality, troponin (if adult), blood cultures stat IV 0.9% saline 15-20 mL/kg in first hour (eg. for adults 1-1.5L stat) if initial K+ < 4mM, give iv KCl to correct K= before starting insulin if pH < 6.9, consider iv sodium bicarbonate (see below) consider empirical iv antibiotics AVOID arterial line unless severe DKA with pH < 6.9 consider prophylactic anticoagulation, esp. if elderly with hyperosmolar state aims of Rx: re-hydrate with 0.9% NS at 4-14 mL/kg/hr ongoing insulin infusion as per protocol 5% dextrose infusion once glucose falls below 15mMol/L at rate of 1L over 8hrs regular blood glucose, blood gas, K+ assessments (eg. hrly initially then 4hrly) monitor for complications: Continue reading >>

Alcoholic Ketoacidosis.

Alcoholic Ketoacidosis.

AKA is an acute metabolic disorder that occurs in ethanol abusers who have usually had a recent binge and who, because of gastritis or another intercurrent illness, stop eating and drinking and often vomit repeatedly. This causes dehydration and ketoacidosis which, unlike in diabetics, is usually associated with little or no hyperglycemia or glucosuria. Despite the ketoacidosis, blood pH findings are variable, depending on the severity of coexisting metabolic alkalosis (owing to vomiting) and respiratory alkalosis (owing to pain or delirium tremens). The metabolic disorders respond rapidly and gratifyingly to parenteral rehydration and administration of glucose, potassium salts, and thiamine. Insulin is usually not necessary, except in patients known or suspected to have diabetes. Because some patients have serious coexisting acute illnesses (which may even have precipitated the acute metabolic disorder), assiduous search for those and the appropriate treatment are essential. The prognosis for the acute metabolic disorder per se is excellent, that for coexisting illness depends on the illness, and that for the ethanol abuse is still often problematic.[1] References Annotations and hyperlinks in this abstract are from individual authors of WikiGenes or automatically generated by the WikiGenes Data Mining Engine. The abstract is from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.About WikiGenesOpen Access LicencePrivacy PolicyTerms of Use Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a serious complication of diabetes mellitus and should be regarded as a medical emergency. DKA is defined as a severe metabolic acidosis of blood (pH <7.35) which occurs secondary to sustained fatty acid (ketones) release from fat stores in response to energy demands experienced by feline diabetic patients. Classically, DKA is characterised by metabolic acidosis, ketosis and ketonuria. It can sometimes be confused with feline hyperosmolar hyperglycaemic state. The two main ketones are acetoacetate and β-hydroxybutyrate, which are produced by the liver and serve as an energy source for tissue in times of low insulin levels. (prolonged fasting, starvation, diabetes mellitus) or insulin resistance[1]. Clinical signs Clinical signs include sudden collapse, dehydration, weakness, depression, vomiting, and an increased respiratory rate. DKA can occur at any age and there is no breed or gender predisposition with this disease. It appears commonly in obese cats or cats with a history of sudden weight gain. Concurrent disease predispose cats, especially diabetic ones to developing DKA. Concurrent illnesses include chronic renal disease, hepatic lipidosis, acute pancreatitis, bacterial or viral infections and neoplasia[2]. Hyperglycaemia and hypoinsulinaemia contribute significantly to a shift of potassium to the extracellular fluid. However, with rehydration, potassium ions are lost from the extracellular fluid and hypokalemia develops rapidly. Insulin therapy may worsen hypokalemia because insulin shifts potassium into cells. The most important clinical significance of hypokalemia in DKA is profound muscle weakness, which may result in ventroflexion of the neck and, in extreme cases, respiratory paralysis. In one study of cats with DKA, most cats Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Source Diabetic ketoacidosis (DKA), often referred to as diabetic coma, is a serious medical situation for individuals with type 1 diabetes. This condition is extremely rare in people with type 2 diabetes. However, type 2 diabetics can experience a non-ketotic syndrome. While the information below focuses on DKA, both conditions can lead to coma, shock, respiratory distress, and death. Luckily, with proper healthcare intervention and continual attention and monitoring, the life-threatening conditions of diabetes can be avoided. What is Diabetic Ketoacidosis? When the amount of sugar rises in the blood, normal metabolic functions begin to malfunction and fail. One disruption is the proper acidity level of the blood. The substance behind the acidity: ketones. When your body does not have enough insulin, such as in untreated diabetes, muscles are unable to get the glucose they require. When they are starved of this nourishment, fat is broken down for their energy source. Ketones are the by-product of this breakdown. When your body does not excrete them faster than they form, the blood becomes poisoned by its high acid levels. Another aspect of DKA is dehydration. This state occurs because glucose is flowing into your urine, while at the same time, your kidneys are producing more urine. The excessive excretion of all this fluid causes the dehydration. Why It Happens An increased blood sugar level is the direct result of an inadequate supply of insulin or the malfunctioning of the insulin that is present. Insulin is a hormone made in the pancreas, which is located in the lower left side of the abdomen. Its production is triggered by the presence of sugar, also known as glucose, in the bloodstream. If insulin is not made or not working properly, glucose is not transported out Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

4 Evaluation 5 Management Defining features include hyperglycemia (glucose > 250mg/dl), acidosis (pH < 7.3), and ketonemia/ketonuria Leads to osmotic diuresis and depletion of electrolytes including sodium, magnesium, calcium and phosphorous. Further dehydration impairs glomerular filtration rate (GFR) and contributes to acute renal failure Due to lipolysis / accumulation of of ketoacids (represented by increased anion gap) Compensatory respiratory alkalosis (i.e. tachypnea and hyperpnea - Kussmaul breathing) Breakdown of adipose creates first acetoacetate leading to conversion to beta-hydroxybutyrate Causes activation of RAAS in addition to the osmotic diuresis Cation loss (in exchange for chloride) worsens metabolic acidosis May be the initial presenting of an unrecognized T1DM patient Presenting signs/symptoms include altered mental status, tachypnea, abdominal pain, hypotension, decreased urine output. Perform a thorough neurologic exam (cerebral edema increases mortality significantly, especially in children) Assess for possible inciting cause (especially for ongoing infection; see Differential Diagnosis section) Ill appearance. Acetone breath. Drowsiness with decreased reflexes Tachypnea (Kussmaul's breathing) Signs of dehydration with dry mouth and dry mucosa. Perform a thorough neurologic exam as cerebral edema increases mortality significantly, especially in children There may be signs from underlying cause (eg pneumonia) Differential Diagnosis Insulin or oral hypoglycemic medication non-compliance Infection Intra-abdominal infections Steroid use Drug abuse Pregnancy Diabetic ketoacidosis (DKA) Diagnosis is made based on the presence of acidosis and ketonemia in the setting of diabetes. Bicarb may be normal due to compensatory and contraction alcoholosis so the Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a serious problem that can occur in people with diabetes if their body starts to run out of insulin. This causes harmful substances called ketones to build up in the body, which can be life-threatening if not spotted and treated quickly. DKA mainly affects people with type 1 diabetes, but can sometimes occur in people with type 2 diabetes. If you have diabetes, it's important to be aware of the risk and know what to do if DKA occurs. Symptoms of diabetic ketoacidosis Signs of DKA include: needing to pee more than usual being sick breath that smells fruity (like pear drop sweets or nail varnish) deep or fast breathing feeling very tired or sleepy passing out DKA can also cause high blood sugar (hyperglycaemia) and a high level of ketones in your blood or urine, which you can check for using home-testing kits. Symptoms usually develop over 24 hours, but can come on faster. Check your blood sugar and ketone levels Check your blood sugar level if you have symptoms of DKA. If your blood sugar is 11mmol/L or over and you have a blood or urine ketone testing kit, check your ketone level. If you do a blood ketone test: lower than 0.6mmol/L is a normal reading 0.6 to 1.5mmol/L means you're at a slightly increased risk of DKA and should test again in a couple of hours 1.6 to 2.9mmol/L means you're at an increased risk of DKA and should contact your diabetes team or GP as soon as possible 3mmol/L or over means you have a very high risk of DKA and should get medical help immediately If you do a urine ketone test, a result of more than 2+ means there's a high chance you have DKA. When to get medical help Go to your nearest accident and emergency (A&E) department straight away if you think you have DKA, especially if you have a high level of ketones in Continue reading >>

Ketoacidosis In A Patient With Type 2 Diabetes – Flatbush Diabetes

Ketoacidosis In A Patient With Type 2 Diabetes – Flatbush Diabetes

There is increasing recognition of a group of patients with type 2 diabetes who can present with ketoacidosis. Most reports have been of patients of African descent; however, the condition has been reported in other groups. This is a case of a Caucasian patient who has had three presentations with ketoacidosis and whose diabetes is not usually insulin-dependent. A patient, aged 48 years, presented with diabetic ketoacidosis (DKA) in a semi-comatose condition. She had a 3-day history of vomiting and loss of appetite. In the previous weeks she had undergone radiotherapy for metastatic squamous cell carcinoma (skin primary). The patient had two similar episodes of DKA, one 20 months and another 3 months earlier. Two of the patient’s brothers had type 2 diabetes. The patient was not abusing alcohol and did not have a history of pancreatitis. Three years prior to this admission the patient had been diagnosed elsewhere with type 2 diabetes, for which she had been on metformin and a small dose of insulin glargine. Two months after stopping her insulin glargine she developed her first episode of DKA while visiting our town. DKA, was diagnosed on the basis of arterial pH 7.03, blood glucose level 25.9 mmol/L, bicarbonate level of 5 mmol/L and positive urinary ketones. It was felt that infected skin lesions may have precipitated the DKA. Eleven days later, she was discharged on metformin 250 mg twice daily and a falling dose of insulin glargine (26 units a day). She was then lost to follow-up in our centre, but apparently soon after did not require insulin and maintained adequate gylcaemic control for 18 months until just prior to her next admission solely on metformin 1 g twice daily. The next admission for DKA occurred while living in a city. She was discharged on insulin but Continue reading >>

Ketoacidosis

Ketoacidosis

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 β-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.[1] 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.[2] Ketosis may also give off an odor, 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. Cause[edit] Three common causes of ketoacidosis are alcohol, starvation, and diabetes, resulting in alcoholic ketoacidosis, starvation ketoacidosis, and diabetic ketoacidosis respectively.[3] In diabetic ketoacidosis, a high concentration of ketone bodies is usually accomp Continue reading >>

Ketoacidosis

Ketoacidosis

Ketoacidosis is a medical emergency caused by hyperglycemia, which results in large amounts of acid in the blood. Ketoacidosis can happen to people with type 1 diabetes; it is rare in people with type 2 diabetes. Untreated ketoacidosis may lead to diabetic coma or death. Ketoacidosis is caused by a buildup in the bloodstream of ketones, acids which are produced when the body burns fat to produce energy. The early symptoms of ketoacidosis include frequent urination, thirst, high blood glucose level, and high levels of ketones in the urine. As the condition develops, the patient may experience constant fatigue, dry or flushed skin, shortness of breath, difficulty paying attention, confusion, and vomiting. The American Diabetes Association list the following causes [1] of Ketones resulting into Ketoacidosis: Not getting enough insulin. Maybe you did not inject enough insulin. Or your body could need more insulin than usual because of illness. If there is not enough insulin, your body begins to break down body fat for energy. Not enough food. When people are sick, they often do not feel like eating. Then, high ketones may result. High ketones may also occur when someone misses a meal. An insulin reaction (low blood glucose). When blood glucose levels fall too low, the body must use fat to get energy. If testing shows high ketones in the morning, the person may have had an insulin reaction while asleep. Ketoacidosis is a very dangerous and serious complication and required immediate medical assistance. It results into complication like: Hypokalemia: a potentially fatal condition in which the body fails to retain sufficient potassium to maintain health. The condition is also known as potassium deficiency. Cerebral edema: Cerebral edema (cerebral oedema in British English) is Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Also known as: DKA Severe diabetic ketoacidosis is a medical emergency and requires prompt treatment to correct dehydration, electrolyte disturbances and acidosis. It is a complication of insulin dependent Diabetes Mellitus. DKA is the result of marked insulin deficiency, and ketonaemia and ketoacidosis occur approximately 15 days after insulin concentrations are suppressed to fasting levels. Marked insulin suppression occurs on average 4 days after fasting glucose levels reach 30mmol/L. Many cats with DKA have other intercurrent conditions which may precipitate the condition including: infection, pancreatitis or renal insufficiency. Pathophysiology Insulin deficiency leads to increased breakdown of fat that releases fatty acids into the circulation. Free fatty acids are oxidised in the liver to ketones that are used by many tissues as an energy source instead of glucose. This occurs when intracellular levels of glucose are insufficient for energy metabolism as a result of severe insulin deficiency. In the liver, instead of being converted to triglycerides, free fatty acids are oxidised to acetoacetate, which is converted to hydroxybutyrate or acetone. Ketones are acids that cause central nervous system depression and act in the chemoreceptor trigger zone to cause nausea, vomiting and anorexia. They also accelerate osmotic water loss in the urine. Dehydration results from inadequate fluid intake in the face of accelerated water loss due to glucosuria and ketonuria. Dehydration and subsequent reduced tissue perfusion compounds the acidosis through lactic acid production. There is whole body loss of electrolytes including sodium, potassium, magnesium and phosphate and there is also intracellular redistribution of electrolytes following insulin therapy which may compound p Continue reading >>

Diabetic Ketoacidosis - Symptoms

Diabetic Ketoacidosis - Symptoms

A A A Diabetic Ketoacidosis Diabetic ketoacidosis (DKA) results from dehydration during a state of relative insulin deficiency, associated with high blood levels of sugar level and organic acids called ketones. Diabetic ketoacidosis is associated with significant disturbances of the body's chemistry, which resolve with proper therapy. Diabetic ketoacidosis usually occurs in people with type 1 (juvenile) diabetes mellitus (T1DM), but diabetic ketoacidosis can develop in any person with diabetes. Since type 1 diabetes typically starts before age 25 years, diabetic ketoacidosis is most common in this age group, but it may occur at any age. Males and females are equally affected. Diabetic ketoacidosis occurs when a person with diabetes becomes dehydrated. As the body produces a stress response, hormones (unopposed by insulin due to the insulin deficiency) begin to break down muscle, fat, and liver cells into glucose (sugar) and fatty acids for use as fuel. These hormones include glucagon, growth hormone, and adrenaline. These fatty acids are converted to ketones by a process called oxidation. The body consumes its own muscle, fat, and liver cells for fuel. In diabetic ketoacidosis, the body shifts from its normal fed metabolism (using carbohydrates for fuel) to a fasting state (using fat for fuel). The resulting increase in blood sugar occurs, because insulin is unavailable to transport sugar into cells for future use. As blood sugar levels rise, the kidneys cannot retain the extra sugar, which is dumped into the urine, thereby increasing urination and causing dehydration. Commonly, about 10% of total body fluids are lost as the patient slips into diabetic ketoacidosis. Significant loss of potassium and other salts in the excessive urination is also common. The most common Continue reading >>

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