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Where Is Ketoacidosis Located

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 >>

Trends In The Prevalence Of Ketoacidosis At Diabetes Diagnosis: The Search For Diabetes In Youth Study

Trends In The Prevalence Of Ketoacidosis At Diabetes Diagnosis: The Search For Diabetes In Youth Study

Abstract OBJECTIVE: To estimate temporal changes in the prevalence of diabetic ketoacidosis (DKA) at diagnosis of type 1 or type 2 diabetes in youth and to explore factors associated with its occurrence. METHODS: Five centers identified incident cases of diabetes among youth aged 0 to 19 years starting in 2002. DKA presence was defined as a bicarbonate level <15 mmol/L and/or a pH <7.25 (venous) or <7.30 (arterial or capillary) or mention of DKA in the medical records. We assessed trends in the prevalence of DKA over 3 time periods (2002–2003, 2004–2005, and 2008–2010). Logistic regression was used to determine factors associated with DKA. RESULTS: In youth with type 1 diabetes (n = 5615), the prevalence of DKA was high and stable over time (30.2% in 2002–2003, 29.1% in 2004–2005, and 31.1% in 2008–2010; P for trend = .42). Higher prevalence was associated with younger age at diagnosis (P < .0001), minority race/ethnicity (P = .019), income (P = .019), and lack of private health insurance (P = 008). Among youth with type 2 diabetes (n = 1425), DKA prevalence decreased from 11.7% in 2002–2003 to 5.7% in 2008–2010 (P for trend = .005). Higher prevalence was associated with younger age at diagnosis (P = .001), minority race/ethnicity (P = .013), and male gender (P = .001). CONCLUSIONS: The frequency of DKA in youth with type 1 diabetes, although stable, remains high, indicating a persistent need for increased awareness of signs and symptoms of diabetes and better access to health care. In youth with type 2 diabetes, DKA at onset is less common and is decreasing over time. Diabetic ketoacidosis (DKA) is a life-threatening condition and often the presenting symptom of newly diagnosed type 1 or type 2 diabetes in youth. SEARCH previously reported that the prev Continue reading >>

Diabetes: What Is Ketoacidosis And How Can Be Avoided & Treated?

Diabetes: What Is Ketoacidosis And How Can Be Avoided & Treated?

Good question! According to Wikipedia: Diabetic ketoacidosis is a potentially life-threatening complication in patients with diabetes mellitus. In order to define ketoacidosis a little better, let's go back to the source: diabetes. Someone who is diabetic is unable to produce insulin, a hormone necessary for the transfer of sugar from the bloodstream to the cells, which in turn produce energy. If this progression is disrupted, through lack of insulin for example, the body has to try to compensate by creating energy elsewhere. And so the body starts to burn fat and muscle to meet its energy needs. Unfortunately, this chemical reaction produces molecules known as ketone bodies. In small quantities, these are fine, and it is in fact normal to have traces of them in your blood (approximately 1mg/dl). However, if the quantity of ketones surpasses this threshold by too much, it starts to affect the pH of your blood (which becomes progressively more acidic). Even the slightest drop in pH can have dangerous effects: as the quantity of the ketones in your blood increases, and the blood pH diminishes, your kidneys start having problems. Eventually, if the ketoacidosis is left untreated, your kidneys can fail and you can die from dehydration, tachycardia and hypotension. A number of other symptoms can appear in extreme cases. Fortunately for us, the quantity of ketones has to be consequential, and it usually takes a while before individuals start manifesting symptoms. In my case, my diabetes went undiagnosed for a month and a half before it was discovered, and even then my ketone levels were relatively normal. If you're a diabetic, ketoacidosis can be easily avoided by controlling your blood sugar levels and maintaining a healthy lifestyle. Some doctors, preferring to stay on the Continue reading >>

How Can I Decrease My Fasting Blood Glucose Levels?

How Can I Decrease My Fasting Blood Glucose Levels?

You asked, How can I decrease my fasting blood glucose levels? The sure fire way is to keep fasting. By fasting into ketosis your blood glucose levels will naturally be fully depleted and then replaced with ketones. Depending upon how long you fast and how much you exercise, your body may quickly develop a new metabolism that is highly efficient and prefers ketones over glucose for fuel. Yet maybe you meant to ask a different question: How do I reverse my insulin intolerance? Fasting is a good prescription, but it is a temporary intervention. You will have to eat again and as far as reversing insulin intolerance you must then start your body on a new dietary path designed to reduce your baseline blood glucose levels, even if you don't remain primarily on a ketone metabolism as you did in the fast. The only way forward to durable improvement in this regard is by a modified diet that reduces and/or eliminates foods that produce glucose, i.e. carbohydrates in all forms, at whatever volumes and frequencies you choose for achieving any improved results you intend. You simply can't exercise your way out of a bad diet... but exercise can help slow the decline that a bad diet will inevitably produce. You are what you eat. Choose wisely... Continue reading >>

Failure To Diagnose: Diabetic Ketoacidosis

Failure To Diagnose: Diabetic Ketoacidosis

A recent coronial inquest examined the death of a patient, 17 years of age, from fulminant diabetic ketoacidosis.1 The patient’s presentation with diabetic ketoacidosis was the first manifestation of the onset of type 1 diabetes. This article examines the Coroner’s findings and recommendations. Download the PDF for the full article. Correspondence [email protected] Continue reading >>

What You Should Know About Diabetic Ketoacidosis

What You Should Know About Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a buildup of acids in your blood. It can happen when your blood sugar is too high for too long. It could be life-threatening, but it usually takes many hours to become that serious. You can treat it and prevent it, too. It usually happens because your body doesn't have enough insulin. Your cells can't use the sugar in your blood for energy, so they use fat for fuel instead. Burning fat makes acids called ketones and, if the process goes on for a while, they could build up in your blood. That excess can change the chemical balance of your blood and throw off your entire system. People with type 1 diabetes are at risk for ketoacidosis, since their bodies don't make any insulin. Your ketones can also go up when you miss a meal, you're sick or stressed, or you have an insulin reaction. DKA can happen to people with type 2 diabetes, but it's rare. If you have type 2, especially when you're older, you're more likely to have a condition with some similar symptoms called HHNS (hyperosmolar hyperglycemic nonketotic syndrome). It can lead to severe dehydration. Test your ketones when your blood sugar is over 240 mg/dL or you have symptoms of high blood sugar, such as dry mouth, feeling really thirsty, or peeing a lot. You can check your levels with a urine test strip. Some glucose meters measure ketones, too. Try to bring your blood sugar down, and check your ketones again in 30 minutes. Call your doctor or go to the emergency room right away if that doesn't work, if you have any of the symptoms below and your ketones aren't normal, or if you have more than one symptom. You've been throwing up for more than 2 hours. You feel queasy or your belly hurts. Your breath smells fruity. You're tired, confused, or woozy. You're having a hard time breathing. Continue reading >>

Diabetic Ketoacidosis In Dogs

Diabetic Ketoacidosis In Dogs

My dog is diabetic. He has been doing pretty well overall, but recently he became really ill. He stopped eating well, started drinking lots of water, and got really weak. His veterinarian said that he had a condition called “ketoacidosis,” and he had to spend several days in the hospital. I’m not sure I understand this disorder. Diabetic ketoacidosis is a medical emergency that occurs when there is not enough insulin in the body to control blood sugar (glucose) levels. The body can’t use glucose properly without insulin, so blood glucose levels get very high, and the body creates ketone bodies as an emergency fuel source. When these are broken down, it creates byproducts that cause the body’s acid/base balance to shift, and the body becomes more acidic (acidosis), and it can’t maintain appropriate fluid balance. The electrolyte (mineral) balance becomes disrupted which can lead to abnormal heart rhythms and abnormal muscle function. If left untreated, diabetic ketoacidosis is fatal. How could this disorder have happened? If a diabetic dog undergoes a stress event of some kind, the body secretes stress hormones that interfere with appropriate insulin activity. Examples of stress events that can lead to diabetic ketoacidosis include infection, inflammation, and heart disease. What are the signs of diabetic ketoacidosis? The signs of diabetic ketoacidosis include: Excessive thirst/drinking Increased urination Lethargy Weakness Vomiting Increased respiratory rate Decreased appetite Weight loss (unplanned) with muscle wasting Dehydration Unkempt haircoat These same clinical signs can occur with other medical conditions, so it is important for your veterinarian to perform appropriate diagnostic tests to determine if diabetic ketoacidosis in truly the issue at hand Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

What is diabetic ketoacidosis? Diabetic ketoacidosis (DKA) is a life-threatening condition caused by a build-up of waste products called ketones in the blood. It occurs in people with diabetes mellitus when they have no, or very low levels of, insulin. DKA mostly occurs in people with type 1 diabetes, but it can also occur in some people with type 2 diabetes and pregnant women with gestational diabetes. Causes Glucose is an essential energy source for the body's cells. When food containing carbohydrates is eaten, it is broken down into glucose that travels around the body in the blood, to be absorbed by cells that use it for energy. Insulin works to help glucose pass into cells. Without insulin, the cells cannot absorb glucose to use for energy. This leads to a series of changes in metabolism that can affect the whole body. The liver attempts to compensate for the lack of energy in the cells by producing more glucose, leading to increased levels of glucose in the blood, also known as hyperglycaemia. The body switches to burning its stores of fat instead of glucose to produce energy. This leads to a build-up of acidic waste products called ketones in the blood and urine. This is known as ketoacidosis, and it can cause heart rhythm abnormalities, breathing changes and abdominal pain. The kidneys try to remove some of the excess glucose and ketones. However, this requires taking large amounts of fluid from the body, which leads to dehydration. This can cause: Increased concentration of ketones in the blood, worsening the ketoacidosis; Loss of electrolytes such as potassium and salt that are vital for the normal function of the body's cells, and; Signs and symptoms Symptoms of DKA can develop over the course of hours. They can include: Increased thirst; Increased frequency Continue reading >>

Systematic Literature Review Of The Incidence And Prevalence Of Diabetic Ketoacidosis Among Adults With Type 1 Diabetes

Systematic Literature Review Of The Incidence And Prevalence Of Diabetic Ketoacidosis Among Adults With Type 1 Diabetes

Search Strategy, v2 (FINAL) Prepared for: Dr. Soulmaz Fazeli Farsani, Global Epidemiology Boehringer Ingelheim GmbH SLR of DKA in Adult T1DM Page 2 of 8 TABLE OF CONTENTS 1.0 INTRODUCTION ..................................................................................................................... 3 2.0 KEY RESEARCH QUESTIONS ............................................................................................... 3 3.0 SEARCH STRATEGY ............................................................................................................. 3 3.1 Data Sources .......................................................................................................................... 3 3.2 Search Filters and Limitations .............................................................................................. 3 3.2.1 Timeframe .................................................................................................................................................. 3 3.2.2 Language and Countries ............................................................................................................................ 3 3.2.3 Humans ...................................................................................................................................................... 4 3.2.4 Publication Status ....................................................................................................................................... 4 4.0 STUDY SELECTION CRITERIA .............................................................................................. 4 4.1 Population .............................................................................................................................. 4 4.2 Interventions/Comparators ........... Continue reading >>

How To Avoid Diabetic Ketoacidosis (dka)

How To Avoid Diabetic Ketoacidosis (dka)

It might have been a really long time since you’ve been in diabetic ketoacidosis (DKA), or maybe you’ve never had it. But if you have Type 1 diabetes, you are at risk. Sometimes when you haven’t recently experienced a situation, you kind of forget about what you were told to do for prevention or treatment. That’s why a refresher might be a great idea! Signs you are experiencing diabetic ketoacidosis: If you are in DKA, it’s likely that you are nauseous or vomiting. Your breath may have a fruity or acetone odor as your body tries to offload ketones through your breathing. It’s likely that you will be dehydrated with very high BG levels and excessive urination. You might have aches and pains, and perhaps blurred vision. Not fun. DKA is serious, and can be life-threatening. Because of dehydration and excessive ketone production, the blood becomes acidic. This is caused by a lack of working insulin. Most cells preferentially burn glucose for fuel. Many cells can also burn fat in small amounts. While glucose burns “cleanly,” fat produces waste products called ketones. Ketones are acid and upset the pH balance, essentially polluting the atmosphere in our bodies. We don’t tend to burn much fat at a time, so small amounts of ketones can usually be broken down and burned off along with glucose. It’s necessary to have enough glucose in the body cells so there is a fuel source, and we also need to have insulin to move the glucose into the cells, where it can be used for energy. If there is no insulin, the glucose can’t get inside the cells. The cells are then forced to burn fat as an energy source, and this causes large amounts of ketones to be produced. Although some ketones will be eliminated through the urine, there will be too many ketones in the bloodstr Continue reading >>

What Is Dka? - Definition, Symptoms & Treatment

What Is Dka? - Definition, Symptoms & Treatment

Diabetic ketoacidosis is a life threatening condition for patients with diabetes. Learn the trigger for, the symptoms of, and the treatment for this terrifying condition in this lesson. What Is Diabetic Ketoacidosis? Everything that goes needs fuel. Your car needs gas, your laptop needs a battery, and you need food! When we eat food, not only are we enjoying something yummy, but we are fueling our body for all the thousands of tasks it is asked to do. We ingest whole food, and our digestive system breaks it down into different components - sugars, fats, proteins - that can be used as fuel. One of the most common types of fuel our bodies use is glucose (a sugar). Now, once the body has broken down the food into glucose, a hormone named insulin helps get the glucose from the bloodstream into the cells. Just like the hose and nozzle at the gas pump help you get gasoline into the tank of your car. Think if you pulled up to a gas station and there was no hose or nozzle; could you get gas? Of course not! And the same is true in our bodies. If there is no insulin, then the glucose is unable to enter the cells to be used as fuel. When the body lacks insulin, like in type 1 diabetes, it cannot use glucose as a fuel. So, it must use something else instead. The glucose is left in the bloodstream, and the body begins to breakdown fats. A byproduct of fat breakdown is ketones. Ketones are highly acidic. As the body continues to breakdown fats, the level of ketones continues to rise making the person's blood highly acidic. This leads to a condition known as diabetic ketoacidosis, commonly abbreviated as DKA. Symptoms of Diabetic Ketoacidosis The symptoms of DKA can be subtle and develop gradually over 24 hours or they can occur much more quickly if a patient is already suffering from Continue reading >>

Pediatric Diabetic Ketoacidosis

Pediatric Diabetic Ketoacidosis

Practice Essentials Diabetic ketoacidosis, in pediatric and adult cases, is a metabolic derangement caused by the absolute or relative deficiency of the anabolic hormone insulin. Together with the major complication of cerebral edema, it is the most important cause of mortality and severe morbidity in children with diabetes. Signs and symptoms Symptoms of acidosis and dehydration include the following: Symptoms of hyperglycemia, a consequence of insulin deficiency, include the following: Patients with diabetic ketoacidosis may also have the following signs and symptoms: Cerebral edema Most cases of cerebral edema occur 4-12 hours after initiation of treatment. Diagnostic criteria of cerebral edema include the following: Major criteria include the following: Minor criteria include the following: See Clinical Presentation for more detail. Laboratory studies The following lab studies are indicated in patients with diabetic ketoacidosis: Imaging studies Head computed tomography (CT) scanning - If coma is present or develops Chest radiography - If clinically indicated Electrocardiography Electrocardiography (ECG) is a useful adjunct to monitor potassium status. Characteristic changes appear with extremes of potassium status. See the images below. Consciousness Check the patient’s consciousness level hourly for up to 12 hours, especially in a young child with a first presentation of diabetes. The Glasgow coma scale is recommended for this purpose. See Workup for more detail. Management Replacement of the following is essential in the treatment of diabetic ketoacidosis: Insulin - Continuous, low-dose, intravenous (IV) insulin infusion is generally considered the safest and most effective insulin delivery method for diabetic ketoacidosis Potassium - After initial resuscitatio Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Definition Diabetic ketoacidosis is a life-threatening problem that affects people with diabetes. It occurs when the body cannot use sugar (glucose) as a fuel source because there is no insulin or not enough insulin. Fat is used for fuel instead. When fat is broken down to fuel the body, chemicals called ketones build up in the body. Causes As fat is broken down, acids called ketones build up in the blood and urine. In high levels, ketones are poisonous. This condition is known as ketoacidosis. Diabetic ketoacidosis (DKA) is sometimes the first sign of type 1 diabetes in people who have not yet been diagnosed. It can also occur in someone who has already been diagnosed with type 1 diabetes. Infection, injury, a serious illness, missing doses of insulin shots, or surgery can lead to DKA in people with type 1 diabetes. People with type 2 diabetes can also develop DKA, but it is less common. It is usually triggered by uncontrolled blood sugar, missing doses of medicines, or a severe illness. Symptoms Common symptoms can include: Dry skin and mouth Flushed face Fruity-smelling breath Headache Exams and Tests Ketone testing may be used in type 1 diabetes to screen for early ketoacidosis. The ketones test is usually done using a urine sample or a blood sample. Ketone testing is usually done when DKA is suspected: Most often, urine testing is done first. If the urine is positive for ketones, most often beta-hydroxybutyrate is measured in the blood. This is the most common ketone measured. Other tests for ketoacidosis include: Basic metabolic panel, (a group of blood tests that measure your sodium and potassium levels, kidney function, and other chemicals and functions) Blood glucose test Blood pressure measurement Treatment The goal of treatment is to correct the high blood su Continue reading >>

Diabetic Ketoacidosis And Cerebral Edema

Diabetic Ketoacidosis And Cerebral Edema

Elliot J. Krane, M.D. Departments of Pediatrics and Anesthesiology Stanford University Medical Center Introduction In 1922 Banting and Best introduced insulin into clinical practice. A decade later the first reported case of cerebral edema complicating diabetic ketoacidosis (DKA) was reported by Dillon, Riggs and Dyer writing in the pathology literature. While the syndrome of cerebral edema complicating DKA was either not seen, ignored, or was unrecognized by the medical community until 3 decades later when the complication was again reported by Young and Bradley at the Joslin Clinic, there has since been a flurry of case reports in the 1960's and 1970's and basic and clinical research from the 1970's to the 1990's leading to our present day acceptance of this as a known complication of DKA, or of the management of DKA. In fact, we now recognize that the cerebral complications of DKA (including much less frequent cerebral arterial infarctions, venous sinus thrombosis, and central nervous system infections) are the most common cause of diabetic-related death of young diabetic patients (1), accounting for 31% of deaths associated with DKA and 20% of all diabetic deaths, having surpassed aspiration, electrolyte imbalance, myocardial infarction, etc. Furthermore, diabetes mellitus remains an important cause of hospitalization of young children. The prevalence rate of diabetes continues to grow in all Western developed nations, nearly doubling every decade, resulting in 22,000 hospital admissions in children under 15 years of age for diabetes in the United States in 1994, the majority of which were due to ketoacidosis. With approximately 4 hospital admissions of children for DKA per 100,000 population per year (2), every PICU located in a major metropolitan center will conti Continue reading >>

Readmission Rates For Children With Diabetic Ketoacidosis (dka)

Readmission Rates For Children With Diabetic Ketoacidosis (dka)

Background: Ketoacidosis is a potentially life threatening complication of diabetes mellitus. Emergency Departments (ED) are usually the first point of contact. Criteria for admission varies and could influence the rate of readmissions. Objective: To describe the population and compare readmission rates of patients treated at Cook Children’s ED for DKA. Methods: A retrospective chart review was preformed of children seen in the Cook Children’s Medical Center ED from September 2011 – August 2014. No attempt was made to classify patients as T1 vs T2. APR-DRG 420 (diabetic ketoacidosis) was used for subject selection. Results: 313 children were seen in the ED with a diagnosis of DKA. Of the total patients seen in the ED, 14% were discharged for home management after initial assessment and treatment; 86% were admitted to the hospital. Of the patients discharged, a median 5.2 hours was spent in the ED. Discharged patients had a median glucose of 285 mg/dL (nl. 74-120 mg/dL), median pH of 7.3 (nl. 7.35-7.45), and median HCO3 of 20.4 mEq/L (nl. 22-28 mEq/L). Of the patients admitted, a median 3.6 hours was spent in the ED. Admitted patients had a median glucose of 437 mg/dL, median pH of 7.2, and median HCO3 of 11.2 mEq/L. Conclusions: DKA is defined as 1) metabolic acidosis (pH < 7.3; HCO3 < 15 mEq/L); 2) hyperglycemia (serum glucose > 200 mg/dL); and 3) ketonemia/ketonuria. It occurs frequently among youth with diabetes and is the main cause of mortality in individuals with diabetes < 24 years of age. DKA is more common in those with T1D, but can also be seen in children with T2D. The metabolic changes in DKA usually occur rapidly and can be fatal, primarily due to cerebral edema. Of the 313 children seen in the ED from September 2011 — August 2014, a large majority Continue reading >>

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