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Where Is Ketoacidosis Found

Euglycemic Diabetic Ketoacidosis, A Misleading Presentation Of Diabetic Ketoacidosis

Euglycemic Diabetic Ketoacidosis, A Misleading Presentation Of Diabetic Ketoacidosis

Go to: Introduction Hyperglycemia and ketosis in diabetic ketoacidosis (DKA) are the result of insulin deficiency and an increase in the counterregulatory hormones glucagon, catecholamines, cortisol, and growth hormone. Three processes are mainly responsible for hyperglycemia: increased gluconeogenesis, accelerated glycogenolysis, and impaired glucose utilization by peripheral tissues. This might also be augmented by transient insulin resistance due to hormone imbalance, as well as elevated free fatty acids.[1] DKA is most commonly precipitated by infections. Other factors include discontinuation of or inadequate insulin therapy, pancreatitis, myocardial infarction, cerebrovascular accident, and illicit drug use. The diagnostic criteria of DKA, established by the American Diabetic Association, consists of a plasma glucose of >250 mg/dL, positive urinary or serum ketones, arterial pH of <7.3, serum bicarbonate <18 mEq/L, and a high anion gap. The key diagnostic feature of DKA is elevated circulating total blood ketone concentration. Hyperglycemia is also a key diagnostic criterion of DKA; however, a wide range of plasma glucose levels can be present on admission. Continue reading >>

What Is The Origin/mechanism Of Abdominal Pain In Diabetic Ketoacidosis?

What Is The Origin/mechanism Of Abdominal Pain In Diabetic Ketoacidosis?

Other than all papers I could find citing the depth of the keto-acidosis (and not the height of the blood glucose levels) correlating with abdominal pain, nothing else to explain how these two are linked. Decades ago, I was taught that because of the keto-acidosis causing a shift of intracellular potassium (having been exchanged for H+ protons of which in keto-acidosis there were too many of in the extracellular fluid) to the extracellular, so also the blood compartment, resulting in hyperkalemia, paralyzing the stomach, which could become grossly dilated - that’s why we often put in a nasogastric drainage tube to prevent vomiting and aspiration - and thus cause “stomach pain”. This stomach pain in the majority of cases indeed went away after the keto-acidosis was treated and serum electrolyte levels normalized. In one patient it didn’t, she remained very, very metabolically acidotic, while blood glucose levels normalized, later we found her to have a massive and fatal intestinal infarction as the underlying reason for her keto-acidosis….. 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 >>

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 >>

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 >>

What Are The Short-term Consequences Of Not Controlling Type 1 Diabetes?

What Are The Short-term Consequences Of Not Controlling Type 1 Diabetes?

Death. Well, that depends on just how poorly controlled you're talking, but if you mean not treating at all, then you can progress through some serious consequences ending in death over the course of a day or so. Unlike the more common Type 2 Diabetes Mellitus, people with Diabetes mellitus type 1 do not produce insulin on their own, and need an external source of insulin to survive. That is because cells cannot take in sugar from the bloodstream to fuel themselves without insulin, so once the sugar in there is used up the cells have to start breaking down fatty acids to stay alive, but that produces ketones, which are toxic. At the same time, all the sugar that's stuck, unusable, in the bloodstream interferes with kidney function, causing dehydration. Its a combination that leads to Diabetic ketoacidosis, which can kill a person within 24 hours of their first symptoms. Ok, so now lets consider a person who is still taking some insulin, but not really paying attention to their blood sugar. It is still possible for them to undertreat themselves, which can potentially still lead to diabetic ketoacidosis. Or, they can overtreat themselves, causing hypoglycaemia, which if only slight might just make them a little woozy, but if severe can lead to unconsciousness and death if they are not found and treated. Easing up a little more, we can imagine a person who's a bit more careful. They still take their insulin, they check their blood sugars relatively often, but they can be a little forgetful about just how many helpings of dessert they had. Their sugars will run high, but there should be enough getting into the cells to prevent DKA. Most of the consequences of that are going to be long-term, like peripheral vascular disease, kidney damage and retinopathy. In the short term, 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 >>

Ketoacidosis At Diabetes Onset Is Still Frequent In Children And Adolescents

Ketoacidosis At Diabetes Onset Is Still Frequent In Children And Adolescents

A multicenter analysis of 14,664 patients from 106 institutions Abstract OBJECTIVE We aimed at analyzing the frequency, clinical characteristics, and trends associated with the occurrence of diabetic ketoacidosis (DKA) at the onset of type 1 diabetes on the basis of long-term follow-up data. RESEARCH DESIGN AND METHODS A total of 106 pediatric diabetes centers in Germany and Austria participated in this study. Data from14,664 patients with type 1 diabetes collected between 1995 and 2007 were suitable for evaluation. DKA was defined and classified according to the International Society for Pediatric and Adolescent Diabetes consensus guidelines. RESULTS DKA was observed in 21.1% of patients. The frequency of DKA, including the severe form, remained unchanged throughout the 13-year observation period. The frequency of DKA was particularly striking among children <5 years of age (26.5%). CONCLUSIONS Ketoacidosis occurring at diabetes onset continues to be a difficult problem. Our data show no significant change in the frequency and magnitude of DKA over the last 13 years. Given that the incidence of type 1 diabetes is rising, and awareness of the disease is thus broadening, it is probably reasonable to expect a drop in the occurrence of diabetic ketoacidosis (DKA) at the onset of diabetes. By means of a computerized follow-up program for diabetic children called the Diabetes Prospective Documentation Initiative or Diabetes Patienten Verlaufsdokumenation (DPV), we analyzed the frequency and clinical characteristics of DKA occurring at the time of diabetes onset in order to ascertain whether a change in the frequency of DKA at diabetes onset was discernible over the last 13 years. RESEARCH DESIGN AND METHODS Data collection Data was collected from 106 pediatric diabetes cente 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 In Type 1 And Type 2 Diabetes Mellitusclinical And Biochemical Differences

Diabetic Ketoacidosis In Type 1 And Type 2 Diabetes Mellitusclinical And Biochemical Differences

Background Diabetic ketoacidosis (DKA), once thought to typify type 1 diabetes mellitus, has been reported to affect individuals with type 2 diabetes mellitus. An analysis and overview of the different clinical and biochemical characteristics of DKA that might be predicted between patients with type 1 and type 2 diabetes is needed. Methods We reviewed 176 admissions of patients with moderate-to-severe DKA. Patients were classified as having type 1 or type 2 diabetes based on treatment history and/or autoantibody status. Groups were compared for differences in symptoms, precipitants, vital statistics, biochemical profiles at presentation, and response to therapy. Results Of 138 patients admitted for moderate-to-severe DKA, 30 had type 2 diabetes. A greater proportion of the type 2 diabetes group was Latino American or African American (P<.001). Thirty-five admissions (19.9%) were for newly diagnosed diabetes. A total of 85% of all admissions involved discontinuation of medication use, 69.2% in the type 2 group. Infections were present in 21.6% of the type 1 and 48.4% of the type 2 diabetes admissions. A total of 21% of patients with type 1 diabetes and 70% with type 2 diabetes had a body mass index greater than 27. Although the type 1 diabetes group was more acidotic (arterial pH, 7.21 ± 0.12 vs 7.27 ± 0.08; P<.001), type 2 diabetes patients required longer treatment periods (36.0 ± 11.6 vs 28.9 ± 8.9 hours, P = .01) to achieve ketone-free urine. Complications from therapy were uncommon. Conclusions A significant proportion of DKA occurs in patients with type 2 diabetes. The time-tested therapy for DKA of intravenous insulin with concomitant glucose as the plasma level decreases, sufficient fluid and electrolyte replacement, and attention to associated problems remai Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Diabetic ketoacidosis, sometimes called DKA, is a condition caused when you have a high blood sugar level, and not enough insulin in your body to break it down to use for energy. As a result, the body starts burning its stores of fat for energy instead. This process produces by-products called ketones. As the level of ketones in the body increases, it can lead to dehydration and confusion. If not treated, people with ketoacidosis can become unconscious. DKA usually occurs in people with type 1 diabetes. It is rare in type 2 diabetes. The symptoms of diabetic ketoacidosis include high blood glucose, high levels of ketones in the urine, and: quick breathing flushed cheeks breath that smells like sweet acetone (similar nail polish remover) dehydration. DKA is a serious condition that requires immediate assessment. If someone you know has diabetes and becomes confused or unconscious, or has the symptoms listed above, call triple zero (000) for an ambulance. If you have diabetes and you find your blood sugar level is higher than it should be, it’s important that you follow the advice provided by your doctor or diabetes nurse or educator. You may also find it useful to read the advice provided in the article on hyperglycaemia (high blood sugar). 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 >>

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 - 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 >>

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 >>

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