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Where Is Ketoacidosis Found

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Print Overview Diabetic ketoacidosis is a serious complication of diabetes that occurs when your body produces high levels of blood acids called ketones. The condition develops when your body can't produce enough insulin. Insulin normally plays a key role in helping sugar (glucose) — a major source of energy for your muscles and other tissues — enter your cells. Without enough insulin, your body begins to break down fat as fuel. This process produces a buildup of acids in the bloodstream called ketones, eventually leading to diabetic ketoacidosis if untreated. If you have diabetes or you're at risk of diabetes, learn the warning signs of diabetic ketoacidosis — and know when to seek emergency care. Symptoms Diabetic ketoacidosis signs and symptoms often develop quickly, sometimes within 24 hours. For some, these signs and symptoms may be the first indication of having diabetes. You may notice: Excessive thirst Frequent urination Nausea and vomiting Abdominal pain Weakness or fatigue Shortness of breath Fruity-scented breath Confusion More-specific signs of diabetic ketoacidosis — which can be detected through home blood and urine testing kits — include: High blood sugar level (hyperglycemia) High ketone levels in your urine When to see a doctor If you feel ill or stressed or you've had a recent illness or injury, check your blood sugar level often. You might also try an over-the-counter urine ketones testing kit. Contact your doctor immediately if: You're vomiting and unable to tolerate food or liquid Your blood sugar level is higher than your target range and doesn't respond to home treatment Your urine ketone level is moderate or high Seek emergency care if: Your blood sugar level is consistently higher than 300 milligrams per deciliter (mg/dL), or 16.7 mill Continue reading >>

How Safe Is It To Drink Hand Sanitizer?

How Safe Is It To Drink Hand Sanitizer?

The consumption of 'alcohol based hand gel' (hand sanitiser) is a relatively common problem in English hospitals. We admit a number of patients to the wards who use the opportunity to drink the sanitiser, it is readily available on all of our wards to attempt to reduce the incidence of hospital acquired infection. A patient of ours was recently found to have consistently raised blood alcohol levels despite being unable to leave hospital because of serious liver problems. After investigation, he was found to be drinking the hand sanitiser which was available in great quantities. EDIT:- the patients who tend to consume this in hospitals are usually substance dependent alcohol users and they are usually likely to drink large quantities. The products usually contain high percentages of ethanol and isopropanol. The toxic effects are reported by the poisons information centre as follows:- Ethanol Severe and potentially fatal 2000-4000 mg/L (200-400 mg/dL, 43.4 - 86.9 mmol/L) - Respiratory depression, hypotension, loss of protective airway reflexes (risk of aspiration), hypothermia, incontinence, coma, hypoglycaemia (particularly in children) which can lead to seizures. Polycythemia has been reported. Cardiac arrhythmias including atrial fibrillation and atrioventricular block have been recorded. Myocardial infarction has been reported after a large acute ingestion (Gowda RM et al, 2003). Metabolic acidosis may be present and may be severe. The degree of acidosis cannot, however, be predicted by blood ethanol concentrations (Zehtabachi et al, 2005). A ketoacidosis may be present particularly following an ethanol binge in patients with a history of chronic ethanol abuse and malnutrition (Peces R, 2008). Isopropanol :- Gastrointestinal: Burning sensation in mouth and throat, nau Continue reading >>

We Can Transfer Information Using All Of Our Sense Organs Except For The Nose. Is There Any Way To Share Information Through Smell?

We Can Transfer Information Using All Of Our Sense Organs Except For The Nose. Is There Any Way To Share Information Through Smell?

Well, the nose knows! It can pick up space: Brain mechanisms for extracting spatial information from smell. Forty years ago, von Békésy demonstrated that the spatial source of an odorant is determined by comparing input across nostrils... found nostril-specific responses in primary olfactory cortex that were predictive of the accuracy of left versus right localization. Additionally, left versus right localization preferentially engaged a portion of the superior temporal gyrus previously implicated in visual and auditory localization, suggesting that localization information extracted from smell was then processed in a convergent brain system for spatial representation of multisensory inputs. It is also used by doctors to pick up signs of ill health: Breath odor - PubMed Health - National Library of Medicine - PubMed Health Diseases that may be associated with breath odor: And affecting chemosensory-dependent behaviors: From odor and pheromone transduction to the organization of the sen... Smell is even used in mate selection: from the animals which identify estrus via hormones in the urine to the detection of Major histocompatibility complexes in sweat, we literally sniff out our mates! MHC genes, body odours, and odour preferences Increasing evidence indicates that the highly polymorphic genes of the major histocompatibility complex (MHC) influence odour and mating preferences in house mice and humans [1]. MHC genes encode cell‐surface glycoproteins (class I and II molecules) that bind short peptides and present them to T lymphocytes. Through this mechanism, MHC genes control the immunological self/non‐self discrimination, and subsequently, tissue rejection and immune recognition of infectious diseases. Thus, it is suspected that the extraordinary polymorphism of Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a serious complication of diabetes mellitus. Before the availability of insulin in the 1920s, DKA was a uniformly fatal disorder. Even after the discovery of insulin, DKA continued to carry a grave prognosis with a reported mortality rate in humans ranging from 10% to 30%. However, with the expanding knowledge regarding the pathophysiology of DKA and the application of new treatment techniques for the complications of DKA, the mortality rate for this disorder has decreased to less than 5% in experienced human medical centers (Kitabchi et al, 2008). We have experienced a similar decrease in the mortality rate for DKA in our hospital over the past two decades. DKA remains a challenging disorder to treat, in part because of the deleterious impact of DKA on multiple organ systems and the frequent occurrence of concurrent often serious disorders that are responsible for the high mortality rate of DKA. In humans, the incidence of DKA has not decreased, appropriate therapy remains controversial, and patients continue to succumb to this complication of diabetes mellitus. This chapter summarizes current concepts regarding the pathophysiology and management of DKA in dogs and cats. • Diabetic ketoacidosis (DKA) is a severe form of complicated diabetes mellitus that requires emergency care. • Acidosis and electrolyte abnormalities can be life threatening. • Fluid therapy and correction of electrolyte abnormalities are the two most important components of therapy. • Concurrent disease increases the risk for DKA and must be addressed as part of the diagnostic and therapeutic plan. • Bicarbonate therapy usually is not needed and its use is controversial. • About 70% of treated dogs and cats are discharged from the hospital after 5 to 6 days Continue reading >>

Is Type One Diabetes As Serious An Illness As Type 2?

Is Type One Diabetes As Serious An Illness As Type 2?

Type 1 diabetes is arguably MORE serious than Type 2 diabetes. Type 1 diabetes is an autoimmune disorder. That means that it is chronic and incurable. Type 1 diabetics do not produce insulin at all. Type 2 is caused by overexposure and thus developed resistance to the insulin. You can, if you are vigilant, recover insulin sensitivity. Like Type 2 diabetes going into remission, to use familiar terms. Type 1 diabetics do not have that chance. Type 2 diabetes is sometimes treated with insulin in vet serious cases, but can usually be controlled with oral medications, diet, and exercise. Type 1 diabetes can ONLY be controlled with artificial insulin injections. Since Type 1 usually emerges in childhood, Type 1 diabetics get to look forward to life as a pincushion. Forever. Both are considered diabetes, but Type 1 and Type 2 are completely and utterly unrelated diseases that just happen to share a set of symptoms. It’s like comparing a child born without a leg to an adult who broke their leg in an accident. Sure, neither of them can walk, but the reasons that neither can walk are completely different, treated differently, and only one of the two ever has the chance to walk unaided in the future. As another comparison, I present US Coast Guard regulations. If you develop Type 1 diabetes, you’ll get medically separated from the military. Yes, the military can fire an employee for having a Type 1 diabetes. If you develop Type 2, you can stay in the military. I wonder which one the Coast Guard considers a greater liability? Continue reading >>

Diabetic Ketoacidosis As First Presentation Of Latent Autoimmune Diabetes In Adult

Diabetic Ketoacidosis As First Presentation Of Latent Autoimmune Diabetes In Adult

Case Reports in Medicine Volume 2015 (2015), Article ID 821397, 3 pages Internal Medicine Department, Texas Tech University Health Sciences Center, Amarillo, TX 79106, USA Academic Editor: Christos D. Lionis Copyright © 2015 Omar Nadhem et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. A 54-year-old white female with hypothyroidism presented with abdominal pain, nausea, vomiting, and diarrhea. She was found to have diabetic ketoacidosis (DKA) and admitted to our hospital for treatment. Laboratory workup revealed positive antiglutamic acid decarboxylase antibodies and subsequently she was diagnosed with latent onset autoimmune diabetes in adult (LADA). She was successfully treated with insulin with clinical and laboratory improvement. Diagnosis of LADA has been based on three criteria as given by The Immunology of Diabetes Society: (1) adult age of onset (>30 years of age); (2) presence of at least one circulating autoantibody (GADA/ICA/IAA/IA-2); and (3) initial insulin independence for the first six months. The importance of this case is the unlikely presentation of LADA. We believe that more research is needed to determine the exact proportion of LADA patients who first present with DKA, since similar cases have only been seen in case reports. Adult patients who are obese and have high blood sugar may deserve screening for LADA, especially in the presence of other autoimmune diseases. Those patients once diagnosed with LADA need extensive diabetic education including potentially serious events such as diabetic ketoacidosis. 1. Introduction Latent autoimmune diabetes in adult (LADA) is an autoimm Continue reading >>

Diabetic Ketoacidosis Explained

Diabetic Ketoacidosis Explained

Twitter Summary: DKA - a major complication of #diabetes – we describe what it is, symptoms, who’s at risk, prevention + treatment! One of the most notorious complications of diabetes is diabetic ketoacidosis, or DKA. First described in the late 19th century, DKA represented something close to the ultimate diabetes emergency: In just 24 hours, people can experience an onset of severe symptoms, all leading to coma or death. But DKA also represents one of the great triumphs of the revolution in diabetes care over the last century. Before the discovery of insulin in 1920, DKA was almost invariably fatal, but the mortality rate for DKA dropped to below 30 percent within 10 years, and now fewer than 1 percent of those who develop DKA die from it, provided they get adequate care in time. Don’t skip over that last phrase, because it’s crucial: DKA is very treatable, but only as long as it’s diagnosed promptly and patients understand the risk. Table of Contents: What are the symptoms of DKA? Does DKA occur in both type 1 and type 2 diabetes? What Can Patients do to Prevent DKA? What is DKA? Insulin plays a critical role in the body’s functioning: it tells cells to absorb the glucose in the blood so that the body can use it for energy. When there’s no insulin to take that glucose out of the blood, high blood sugar (hyperglycemia) results. The body will also start burning fatty acids for energy, since it can’t get that energy from glucose. To make fatty acids usable for energy, the liver has to convert them into compounds known as ketones, and these ketones make the blood more acidic. DKA results when acid levels get too high in the blood. There are other issues too, as DKA also often leads to the overproduction and release of hormones like glucagon and adrenaline Continue reading >>

If You Were A Doctor And You Misdiagnosed And Mistreated A Patient Who Afterward Sought Care Successfully From Someone Else, Would You Want To Know About Your Mistake?

If You Were A Doctor And You Misdiagnosed And Mistreated A Patient Who Afterward Sought Care Successfully From Someone Else, Would You Want To Know About Your Mistake?

Before answering this question I will make a few clarifications. Misdiagnosed and hence mistreated is not unusual. It is more common than you think. The public needs to know that all wrong diagnoses are not medical negligence. Every doctor, I repeat every single doctor you ever know has made wrong diagnoses in his career. And most of them would like to know about their mistakes because it is a learning experience and they would like to avoid making them in the future. Diseases don't follow set guidelines or protocols. Their presentations can be so myriad that it is impossible to be hundred per cent sure. Hence every patient becomes a learning experience for the doctor and he must strive to know the results and follow up of both his successes and failures. Having said that in the current litigation and anti doctor mood that prevails among the general public, every mistake is viewed as negligence. This is further compounded by the attitude and behavior of the second doctor who in the glory of his successful diagnosis tries to put down the efforts of the previous doctor. They think that criticizing another doctor makes them look more superior and knowledgeable. Ultimately patients pounce on doctors even for genuinely unavoidable mistakes. This leads to a defensive reaction where doctors fail to acknowledge their mistakes and thus may never learn from themresulting in more mistakes. The public can't really help with this. Most of them will continue to view mistakes as negligence. It's entirely upto the doctors who get the second chance to successfully treat them to explain and clarify if the first attempt was indeed a genuine mistake or was grossly negligent. Hence doctors must assume dual responsibility. They must know their mistakes and acknowledge them and they must at t 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 >>

Ketosis Vs. Ketoacidosis: What You Should Know

Ketosis Vs. Ketoacidosis: What You Should Know

Despite the similarity in name, ketosis and ketoacidosis are two different things. Ketoacidosis refers to diabetic ketoacidosis (DKA) and is a complication of type 1 diabetes mellitus. It’s a life-threatening condition resulting from dangerously high levels of ketones and blood sugar. This combination makes your blood too acidic, which can change the normal functioning of internal organs like your liver and kidneys. It’s critical that you get prompt treatment. DKA can occur very quickly. It may develop in less than 24 hours. It mostly occurs in people with type 1 diabetes whose bodies do not produce any insulin. Several things can lead to DKA, including illness, improper diet, or not taking an adequate dose of insulin. DKA can also occur in individuals with type 2 diabetes who have little or no insulin production. Ketosis is the presence of ketones. It’s not harmful. You can be in ketosis if you’re on a low-carbohydrate diet or fasting, or if you’ve consumed too much alcohol. If you have ketosis, you have a higher than usual level of ketones in your blood or urine, but not high enough to cause acidosis. Ketones are a chemical your body produces when it burns stored fat. Some people choose a low-carb diet to help with weight loss. While there is some controversy over their safety, low-carb diets are generally fine. Talk to your doctor before beginning any extreme diet plan. DKA is the leading cause of death in people under 24 years old who have diabetes. The overall death rate for ketoacidosis is 2 to 5 percent. People under the age of 30 make up 36 percent of DKA cases. Twenty-seven percent of people with DKA are between the ages of 30 and 50, 23 percent are between the ages of 51 and 70, and 14 percent are over the age of 70. Ketosis may cause bad breath. Ket Continue reading >>

Diabetic Ketoacidosis: Not Always Due To Type 1 Diabetes

Diabetic Ketoacidosis: Not Always Due To Type 1 Diabetes

This article discusses how to diagnose and manage patients with ketosis prone type 2 diabetes Patients presenting with diabetic ketoacidosis may have type 1 or type 2 diabetes Diabetic ketoacidosis should be treated with insulin in accordance with nationally agreed guidance After treatment of diabetic ketoacidosis, patients found to have type 2 diabetes may not require lifelong insulin treatment Consider ketosis prone type 2 diabetes in older, overweight, non-white patients who present with diabetic ketoacidosis at their first presentation of diabetes; this diagnosis is also a possibility in patients with any features that are atypical for type 1 diabetes Discharge all patients on insulin and arrange for specialist follow-up Under specialist supervision consider whether insulin can be down-titrated on the basis of clinical progress and, where possible, C peptide and antibody measurements Who gets diabetic ketoacidosis? Diabetic ketoacidosis (DKA) is not just the hallmark of absolute insulin deficiency in type 1 diabetes—it is increasingly being seen in people presenting with type 2 diabetes.1 2 This is at odds with traditional physiological teaching—that clinically significant ketosis does not occur in the presence of insulin concentrations associated with type 2 diabetes because there will always be sufficient insulin to suppress lipolysis (fig 1⇓).3 Current knowledge suggests that some people with type 2 diabetes may develop acute reductions in insulin production, which, coupled with insulin resistance, can cause DKA, usually without a precipitant.4 This is particularly so in African-Caribbean and other non-white ethnic groups.5 6 This potentially life threatening presentation of type 2 diabetes is referred to as ketosis prone type 2 diabetes (also Flatbush or t Continue reading >>

Diabetic Ketoacidosis Characteristics And Differences In Type 1 Versus Type 2 Diabetes Patients.

Diabetic Ketoacidosis Characteristics And Differences In Type 1 Versus Type 2 Diabetes Patients.

Abstract BACKGROUND: Diabetes is undoubtedly one of the most challenging health problems of the 21st century. It is well known that diabetes once develop can lead to several complications. Diabetic ketoacidosis (DKA) is one of the life-threatening complications of diabetes. This study was designed to determine the frequency of DKA in diabetes patients and find out the clinical and biochemical determinants of DKA. METHODS: This descriptive study was conducted at Aga Khan University Hospital (AKUH) Karachi, Pakistan from January 2010 to February 2016. All known or newly diagnosed diabetic patients of >16 years of age irrespective of gender and type of diabetes were included. Information regarding patient's demographics, presenting symptoms, precipitating causes of DKA, biochemical profiles and outcome at the time of discharge was collected. RESULTS: Majority (54.7%) had moderate and 12.4% had severe DKA at presentation. Previous history of DKA was found higher in type 1 diabetes patients (T1DM) (14%) as compare to (4%) type 2 diabetes patients (T2DM) (p<0.05). DKA severity was observed more (12%) in newly diagnosed (T1DM) (p<0.05). Comorbidities were found more (81%) in (T2DM) (p<0.05) Mortality was also observed higher in Type 2 diabetes patients (p<0.05). CONCLUSIONS: Majority of the diabetics had moderate to severe DKA at presentation. Mortality and morbidity related with DKA was found considerably higher among patients with T2DM while infection, myocardial infarction and stroke found as triggering factors in these patients. Continue reading >>

How Do You Know If You Are In Ketosis?

How Do You Know If You Are In Ketosis?

There are 3 ways to directly measure ketosis: Urine test strips, like Ketostix - these stop working for most people after a couple of weeks because they only catch very high numbers, which are more important for a Type 1 Diabetic in danger of ketoacidosis. It’s also prone to error - dehydration will cause a false positive. In the first couple weeks on a ketogenic diet, your body is spilling out alot of extra ketones, but once your body is burning them efficiently, they don’t spill out anymore. They’re inexpensive, and can be ok to get you started, but I found them to be more discouraging in the long run. Blood test strips - this is accurate, but very expensive at the moment. The cheapest I’ve heard of is still over $1 per strip. Breath ketones - the only one I know of available for sale is the Ketonix Reusable Breath Ketone Analyzer in the US, or Home in the rest of the world. I have this one and like it alot. It cost about $200, but I’ve been able to adjust my diet and correlate how clear headed I feel to the number on the meter. Once you’ve measured a while, you generally can tell when you’re in because you’re thinking more clearly, and often have more energy over all, though the energy can still be down if you’re not sleeping well, stressed all the time, etc. Continue reading >>

Diabetic Ketoacidosis (dka) - Topic Overview

Diabetic Ketoacidosis (dka) - Topic Overview

Diabetic ketoacidosis (DKA) is a life-threatening condition that develops when cells in the body are unable to get the sugar (glucose) they need for energy because there is not enough insulin. When the sugar cannot get into the cells, it stays in the blood. The kidneys filter some of the sugar from the blood and remove it from the body through urine. Because the cells cannot receive sugar for energy, the body begins to break down fat and muscle for energy. When this happens, ketones, or fatty acids, are produced and enter the bloodstream, causing the chemical imbalance (metabolic acidosis) called diabetic ketoacidosis. Ketoacidosis can be caused by not getting enough insulin, having a severe infection or other illness, becoming severely dehydrated, or some combination of these things. It can occur in people who have little or no insulin in their bodies (mostly people with type 1 diabetes but it can happen with type 2 diabetes, especially children) when their blood sugar levels are high. Your blood sugar may be quite high before you notice symptoms, which include: Flushed, hot, dry skin. Feeling thirsty and urinating a lot. Drowsiness or difficulty waking up. Young children may lack interest in their normal activities. Rapid, deep breathing. A strong, fruity breath odor. Loss of appetite, belly pain, and vomiting. Confusion. Laboratory tests, including blood and urine tests, are used to confirm a diagnosis of diabetic ketoacidosis. Tests for ketones are available for home use. Keep some test strips nearby in case your blood sugar level becomes high. When ketoacidosis is severe, it must be treated in the hospital, often in an intensive care unit. Treatment involves giving insulin and fluids through your vein and closely watching certain chemicals in your blood (electrolyt Continue reading >>

Ketoacidosis At First Presentation Of Type 1 Diabetes Mellitus Among Children: A Study From Kuwait

Ketoacidosis At First Presentation Of Type 1 Diabetes Mellitus Among Children: A Study From Kuwait

Go to: We examined the frequency and severity of diabetic ketoacidosis (DKA) in 679 children and adolescents (0–14 years) at diagnosis of Type 1 Diabetes Mellitus (T1DM) in Kuwait. Between 1st January 2011 and 31st December 2013, all newly diagnosed children with diabetes were registered prospectively in a population-based electronic register. DKA was diagnosed using standard criteria based on the levels of venous pH and serum bicarbonate. At the time of diagnosis, mild/moderate DKA was present in 24.8% of the children, while severe DKA was present in 8.8%. Incidence of ketoacidosis was significantly higher in young children less than 2 (60.7% vs 32.4% p = <0.005) compared to children 2–14 years old, and a higher proportion presented with severe DKA (21.4% vs 8.3% p = <0.05). No association was seen with gender. Significant differences were found in the incidence of DKA between Kuwaiti and non-Kuwaiti children (31.1% vs 39.8%; p < 0.05). Family history of diabetes had a protective effect on the occurrence of DKA (OR = 0.44; 95% CI = 0.27–0.71). Incidence of DKA in children at presentation of T1DM remains high at 33.6%. Prevention campaigns are needed to increase public awareness among health care providers, parents and school teachers in Kuwait. Diabetic ketoacidosis (DKA) is a serious life threatening complication of type 1 diabetes mellitus (T1DM) and constitutes a medical emergency with significant morbidity and mortality1, mostly due to cerebral edema during the course of resuscitation2,3. Worldwide, approximately 65,000 children aged under 15 years develop T1DM each year, and 13% to 80% of these children present with DKA at the time of diagnosis4. The highest frequencies for DKA at presentation of T1DM are seen in Saudi Arabia (44.9%)5, Taiwan (65%), Romania Continue reading >>

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