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What Precipitating Factors May Lead To Dka?

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DKA (Diabetic Ketoacidosis) Vs HHNS (Hyperosmolar Hyperglycemic Nonketotic Syndrome) Tables From Step Up to Medicine (3rd Edition, Agabegi) Here is the link for the Quick Hits =) http://imgur.com/TnJPBmu

Diabetic Ketoacidosis And Hyperglycemic Hyperosmolar Syndrome

In Brief Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic syndrome (HHS) are two acute complications of diabetes that can result in increased morbidity and mortality if not efficiently and effectively treated. Mortality rates are 2–5% for DKA and 15% for HHS, and mortality is usually a consequence of the underlying precipitating cause(s) rather than a result of the metabolic changes of hyperglycemia. Effective standardized treatment protocols, as well as prompt identification and treatment of the precipitating cause, are important factors affecting outcome. The two most common life-threatening complications of diabetes mellitus include diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar syndrome (HHS). Although there are important differences in their pathogenesis, the basic underlying mechanism for both disorders is a reduction in the net effective concentration of circulating insulin coupled with a concomitant elevation of counterregulatory hormones (glucagon, catecholamines, cortisol, and growth hormone). These hyperglycemic emergencies continue to be important causes of morbidity and mortality among patients with diabetes. DKA is reported to be responsible fo Continue reading >>

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  1. ch1nese_pr0verb

    i've tried them as just something extra to drink during the day besides water, and also as part of my spin-class workout drink. not sure if they do anything?
    my am ketones don't go up at all. maybe more ability with endurance but only tried it twice so not sure. anybody have experience good or bad that they have discovered?

  2. undertaker-_-

    From what I've heard and slightly researched (don't have any links), exogenous ketones give a boost in energy slightly to athletes. But to the average person they're a waste of money. The benefits of weight loss from ketones come from your body producing them, not just from merely having them in your system.

  3. ch1nese_pr0verb

    That's what I experienced but don't usually trust myself to be free of placebo. And I still want to lose some weight, so far now I think I'll stick with producing my own ketones from body fat.

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A lecture on the recognition, pathogenesis, and management of diabetic ketoacidosis and the hyperosmolar hyperglycemic state. Use of the VA and Stanford name/logos is only to indicate my academic affiliation, and neither implies endorsement nor ownership of the included material.

Hyperglycemic Crises In Adult Patients With Diabetes

Hyperglycemic Crises in Adult Patients With Diabetes Abbas E. Kitabchi, PHD, MD; Guillermo E. Umpierrez, MD; John M. Miles, MD; Joseph N. Fisher, MD The most common precipitating factor in the development of DKA and HHS is infection[ 1 , 4 , 10 ]. Other precipitating factors include discontinuation of or inadequate insulin therapy, pancreatitis, myocardial infarction, cerebrovascular accident, and drugs[ 10 , 13 , 14 ]. In addition, new-onset type 1 diabetes or discontinuation of insulin in established type 1 diabetes commonly leads to the development of DKA. In young patients with type 1 diabetes, psychological problems complicated by eating disorders may be a contributing factor in 20% of recurrent ketoacidosis. Factors that may lead to insulin omission in younger patients include fear of weight gain with improved metabolic control, fear of hypoglycemia, rebellion against authority, and stress of chronic disease. Before 1993, the use of continuous subcutaneous insulin infusion devices had also been associated with an increased frequency of DKA[ 23 ]; however, with improvement in technology and better education of patients, the incidence of DKA appears to have reduced in pump use Continue reading >>

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  1. Michael Simpson

    Diabetic ketoacidosis (the formal name, and the one most diabetics use, abbreviating it as DKA) can happen in Type 2 diabetics, but as you implied it is rare.
    Type 1 diabetics totally lack or have insufficient amounts of insulin. So the body produces the antagonistic hormone, glucagon, because there's no insulin, which to the body means there's low glucose. Glucagon then induces the liver to use fat as energy, producing ketone bodies while also forcing the liver to convert glycogen to glucose. Unfortunately, the blood glucose levels are high because the Type 1 Diabetic has no insulin. This causes the blood osmolarity to skyrocket, and the kidneys try to compensate by removing ketones and glucose from the blood.
    Since the kidneys have a maximum capacity to clear excess glucose from the blood, the blood becomes more acidotic and ketone bodies rise at the same time. And that leads to more serious issues like coma and death.
    The feedback systems are all broken, so the body spins out of control. It is often the first sign of Type 1 diabetes.
    So the one difference between Type 1 and Type 2 diabetics is that Type 1 has no insulin, but Type 2 generally has insulin in the blood to suppress the release of glucagon. And this is why it's rare in Type 2 diabetics.

  2. Liang-Hai Sie

    We need insulin to be able to utilize glucose, type 2 has some insulin, not enough because of the insulin resistance, type 1 don't, so in type one ketosis can develop because the lack of insulin causes the body to burn fat that forms ketones if no inslin is administered. I knew a man who every time he was arrested by intent "forgot" to inject his insulin so ended in hospital with a keto-aciditic diabetic coma, out of jail.

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Visit us (http://www.khanacademy.org/science/he...) for health and medicine content or (http://www.khanacademy.org/test-prep/...) for MCAT related content. These videos do not provide medical advice and are for informational purposes only. The videos are not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of a qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read or seen in any Khan Academy video. Created by Matthew McPheeters. Watch the next lesson: https://www.khanacademy.org/test-prep... Missed the previous lesson? https://www.khanacademy.org/test-prep... NCLEX-RN on Khan Academy: A collection of questions from content covered on the NCLEX-RN. These questions are available under a Creative Commons Attribution-NonCommercial-ShareAlike 3.0 United States License (available at http://creativecommons.org/licenses/b...). About Khan Academy: Khan Academy offers practice exercises, instructional videos, and a personalized learning dashboard that empower learners to study at their own pace in and outside of the classroom. We tackle math, science, computer programming, history, art history, economics, and more. Our math missions guide learners from kindergarten to calculus using state-of-the-art, adaptive technology that identifies strengths and learning gaps. We've also partnered with institutions like NASA, The Museum of Modern Art, The California Academy of Sciences, and MIT to offer specialized content. For free. For everyone. Forever. #YouCanLearnAnything Subscribe to Khan Academys NCLEX-RN channel: https://www.youtube.com/channel/UCDx5... Subscribe to Khan Academy: https://www.youtube.com/subscription_...

Hyperosmolar Hyperglycemic State

Acute hyperglycemia, or high blood glucose, may be either the initial presentation of diabetes mellitus or a complication during the course of a known disease. Inadequate insulin replacement (e.g., noncompliance with treatment) or increased insulin demand (e.g., during times of acute illness, surgery, or stress) may lead to acute hyperglycemia. There are two distinct forms: diabetic ketoacidosis (DKA), typically seen in type 1 diabetes, and hyperosmolar hyperglycemic state (HHS), occurring primarily in type 2 diabetes. In type 1 diabetes, no insulin is available to suppress fat breakdown, and the ketones resulting from subsequent ketogenesis manifest as DKA. This is in contrast to type 2 diabetes, in which patients can still secrete small amounts of insulin to suppress DKA, instead resulting in a hyperglycemic state predominated simply by glucose. The clinical presentation of both DKA and HHS is one of polyuria, polydipsia, nausea and vomiting, volume depletion (e.g., dry oral mucosa, decreased skin turgor), and eventually mental status changes and coma. In patients with altered mental status, fingerstick glucose should always be checked in order to exclude serum glucose abnormalit Continue reading >>

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  1. Injecto

    I can't seem to find anything that backs this up. I know that high BG will damage them over time (duh!!), but what about ketones?

  2. fgummett

    Ketone bodies are water-soluble compounds that are produced as by-products when fatty acids are broken down for energy. They are a vital source of energy during fasting -- such as overnight.
    The brain gets its energy from ketone bodies when insufficient glucose is available. In the event of low blood glucose, most other tissues have additional energy sources besides ketone bodies (such as fatty acids), but the brain does not.
    Remember that when you are not fasting, the body can use Amino Acids (from dietary Protein) to synthesize Glucose (Gluconeogenesis).
    Any production of Ketones is called ketogenesis, and this is necessary in small amounts. When even larger amounts of ketone bodies accumulate such that the blood's pH is lowered to dangerously acidic levels, this state is called ketoacidosis. This happens in untreated Type I diabetes (DKA).
    In short, the human body has evolved over the millennia to burn either Glucose or Fatty Acids -- think of these as the short-term fuel and longer-term reserve, respectively.
    So if it is normal to burn Fatty Acids and produce Ketones why would they be harmful unless they accumulate to dangerous levels? Yes I know... we always get the "dangerous levels" lecture but consider that BG can be toxic at high enough levels... that does not mean it is bad for us at any level

  3. REDLAN

    can we get the production of ketones correct??
    The primary cause of ketogenesis in the body is.....
    gluconeogenesis from dietary protein, when there is insufficient dietary glucose to fill the body needs, aka the ketogenic diet.
    The process of gluconeogenesis utilises a key component of the citric acid cycle (oxaloacetate), which blocks the oxidation of Acetyl CoA. Fatty acid (and glucose oxidation) require their conversion to Acetyl CoA. It is Acetyl CoA which is converted to ketone bodies and this process occurs pretty exclusively in the liver (also happens in the kidney)
    Normally oxidation of fatty acids does NOT produce ketone bodies, even during fasting overnight, as usually there are more than sufficient stores of glycogen.
    - starvation is an entirely different matter. Fasting for longer than a day or so can be sufficient for ketogenesis to start.
    Astrocytes in the brain can produce ketone bodies in response to hypoglycemia, but this will not provide adequate protection in the event of hypoglycemia caused by insulin overdose.
    The simple reason why ketogenesis as caused by a ketogenic diet is probably safe is because ketones only transiently rise in response to food, and the levels sustained should not be sufficient to disturb the body's buffer system.
    if however you spent long periods without food, or lacking insulin then that is a very different matter.
    I can't find anything definitive about ketones and kidney function - the only thing of note is an association with kidney stones for children on ketogenic diets to control epilepsy - but this could be due to the components of the diet (high protein) rather than ketones. There are no long term safety studies on ketogenic diets, but they are though to be safe (probably).
    Those on this forum on low carbohydrate diets 50g to 120g of carbs probably do not experience ketogenesis to any significant degree. Significant ketogenesis only occurs at <30g.

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