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Why Do You Get Kussmaul Breathing In Dka?

Diabetic Ketoacidosis

Diabetic Ketoacidosis

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

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Patient professional reference Professional Reference articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use. You may find the Pre-diabetes (Impaired Glucose Tolerance) article more useful, or one of our other health articles. See also the separate Childhood Ketoacidosis article. Diabetic ketoacidosis (DKA) is a medical emergency with a significant morbidity and mortality. It should be diagnosed promptly and managed intensively. DKA is characterised by hyperglycaemia, acidosis and ketonaemia:[1] Ketonaemia (3 mmol/L and over), or significant ketonuria (more than 2+ on standard urine sticks). Blood glucose over 11 mmol/L or known diabetes mellitus (the degree of hyperglycaemia is not a reliable indicator of DKA and the blood glucose may rarely be normal or only slightly elevated in DKA). Bicarbonate below 15 mmol/L and/or venous pH less than 7.3. However, hyperglycaemia may not always be present and low blood ketone levels (<3 mmol/L) do not always exclude DKA.[2] Epidemiology DKA is normally seen in people with type 1 diabetes. Data from the UK National Diabetes Audit show a crude one-year incidence of 3.6% among people with type 1 diabetes. In the UK nearly 4% of people with type 1 diabetes experience DKA each year. About 6% of cases of DKA occur in adults newly presenting with type 1 diabetes. About 8% of episodes occur in hospital patients who did not primarily present with DKA.[2] However, DKA may also occur in people with type 2 diabetes, although people with type 2 diabetes are much more likely to have a hyperosmolar hyperglycaemic state. Ketosis-prone type 2 diabetes tends to be more common in older, overweight, non-white people with type 2 diabetes, and DKA may be their Continue reading >>

Respiratory System And Diabetes

Respiratory System And Diabetes

Tweet The respiratory system is the system of organs that allow the body to take in oxygen and expel carbon dioxide, this process is known as gaseous exchange. We generally breathe between 12 and 20 times a minute. There are a number of complications of diabetes that can negatively affect our breathing. Parts of the respiratory system The following parts of the body make up the respiratory system: Mouth and nose Trachea (windpipe) Lungs Diaphragm How the respiratory system works Breathing is usually initiated by contraction of the diaphragm, a muscle which separates the chest cavity from the abdomen. As the diaphragm contracts, more space is made available in the chest cavity and this has the effect of creating suction as the lungs expand to fill the space. The lungs draw in air through the nose and/or mouth which then travels down the trachea (windpipe) before reaching the lungs. Within the lungs are tiny air sacs called alveoli which allow oxygen from the air we breathe to be absorbed into the many tiny blood vessels contained with the alveoli. As this happens, the alveoli take in carbon dioxide from the blood vessels and this completes gaseous exchange. With gaseous exchange complete, the diaphragm relaxes and the carbon dioxide rich air in the lungs is expelled via the trachea out of the mouth and/or nose. The lungs As noted above, it is within the lungs that the gaseous exchange of oxygen and carbon dioxide takes place. The lungs are filled with a branched structure of airways called bronchi and smaller airways called bronchioles. Located at the end of the bronchioles are the alveoli in which the exchange of gases takes place. The average capacity of human lungs is between 4 and 6 litres of air. The capacity of lungs may be reduced if the lungs become diseased or d 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 >>

Cheyne Stokes Breathing And Other Abnormal Respiration

Cheyne Stokes Breathing And Other Abnormal Respiration

Cheyne Stokes breathing is a type of abnormal breathing. It’s characterized by a gradual increase in breathing, and then a decrease. This pattern is followed by a period of apnea where breathing temporarily stops. The cycle then repeats itself. Normal breathing, the process of moving air in and out of the lungs 12 to 20 times per minute, is something most people seldom think about. However, abnormal breathing like Cheyne Stokes is serious and may be frightening. When does it most likely occur? According to research, Cheyne Strokes breathing can happen while you’re awake, but is more common during sleep. It may happen more during non-rapid eye movement (NREM) sleep than rapid eye movement (REM) sleep. When Cheyne Stokes occurs during sleep, it’s considered a form of central sleep apnea with an extended period of fast breathing (hyperventilation). Central sleep apnea causes you to stop breathing briefly and increases the levels of carbon dioxide in your body. Cheyne Stokes is usually related to heart failure or stroke. It may also be caused by: brain tumors traumatic brain injuries high altitude sickness encephalitis increased intercranial pressure chronic pulmonary edema People who are dying often experience Cheyne Stokes breathing. This is a natural effect of the body’s attempt to compensate for changing carbon dioxide levels. While it may be distressing to those who witness it, there’s no evidence Cheyne Stokes is stressful for the person experiencing it. Both Kussmaul breathing and Cheyne Stokes breathing are characterized by fast breathing and too much carbon dioxide in the body, but that’s where their similarities end. Kussmaul breathing doesn’t alternate between fast and slow breathing or cause breathing to stop like Cheyne Stokes does. Instead, it’ Continue reading >>

Ketoacidosis In Cats – Causes, Symptoms & Treatment

Ketoacidosis In Cats – Causes, Symptoms & Treatment

Ketoacidosis in cats at a glance Ketoacidosis is a serious complication of diabetes in which ketones and blood sugar levels build up in the body due to insufficient levels of insulin which is required to move glucose into the cells for energy. As a result, the body uses fat as an alternate energy source which produces ketones causing the blood to become too acidic. Common causes include uncontrolled diabetes, missed or insufficient insulin, surgery, infection, stress and obesity. Symptoms of ketoacidosis include increased urination and thirst, dehydration, nausea, diarrhea, confusion, rapid breathing which may later change to laboured breathing. What is diabetic ketoacidosis? Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes characterised by metabolic acidosis (increased acids in the blood), hyperglycemia (high blood glucose) and ketonuria (ketones in the urine). It is caused by a lack of or insufficient amounts of insulin which is required to move glucose from the bloodstream and into the cells to be used for energy. When this occurs, the body begins to search for alternate sources of energy and begins to break down fat. When fat is broken down (metabolised) into fatty acids, waste products known as ketones (acetoacetate, beta-hydroxybutyrate, acetone) are released from the liver and accumulate in the bloodstream (known as ketonemia). This causes the blood to become too acidic (metabolic acidosis). As well as metabolic acidosis, ketones also cause central nervous depression.The body will try to get rid of the ketones by excreting them out of the body via the urine, increased urine output leads to dehydration, making the problem worse. Meanwhile, the unused glucose remains in the bloodstream, resulting in hyperglycemia (high blood sugar).Insulin Continue reading >>

Diabetic Ketoacidosis – Its Causes And Its Treatments

Diabetic Ketoacidosis – Its Causes And Its Treatments

Certified diabetes educator Becky Wells recently retired from working with a diabetes self-management education program at Hendrick Medical Center in Abilene, Texas. She provides advice on diabetes for Insulin Nation. Question: What is diabetic ketoacidosis and how can I prevent it? Answer: Diabetic ketoacidosis (DKA) is a possible complication of diabetes that can cause kidney damage and may prove fatal if left untreated. It is more common with Type 1 diabetes than with Type 2 diabetes, and many with Type 1 are experiencing DKA when first diagnosed with Type 1. The condition results from an insulin deficiency that may have come about from undiagnosed diabetes, a forgotten insulin injection, a malfunctioning insulin pump, an illness, psychological stress, an eating disorder, or insulin that was incorrectly stored. In ketoacidosis, a lack of insulin causes the body to go into starvation mode. This is because insulin is necessary for glucose to enter most of the body’s cells. The body instead tries to get energy for its processes by breaking down fatty acids. With this breakdown, ketones are formed in the bloodstream, and this causes a decrease in the blood’s pH levels. Without enough insulin, the glucose absorbed from the stomach and intestines causes hyperglycemia. The kidneys must work hard to rid the body of glucose by producing more urine. This process will dehydrate the body unless enough fluids are being taken in to replace what’s lost. One other symptom of DKA is what is called Kussmaul breathing – when breathing gets rapid and deeper, and smells fruity. This symptom comes from the lungs blowing off the acid from the bloodstream, an attempt to correct the acidosis. sponsor Early treatment can often prevent a hospital admission, but blood glucose needs to b Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Diabetes mellitus is the name given to a group of conditions whose common hallmark is a raised blood glucose concentration (hyperglycemia) due to an absolute or relative deficiency of the pancreatic hormone insulin. In the UK there are 1.4 million registered diabetic patients, approximately 3 % of the population. In addition, an estimated 1 million remain undiagnosed. It is a growing health problem: In 1998, the World Health Organization (WHO) predicted a doubling of the worldwide prevalence of diabetes from 150 million to 300 million by 2025. For a very tiny minority, diabetes is a secondary feature of primary endocrine disease such as acromegaly (growth hormone excess) or Cushing’s syndrome (excess corticosteroid), and for these patients successful treatment of the primary disease cures diabetes. Most diabetic patients, however, are classified as suffering either type 1 or type 2 diabetes. Type 1 diabetes Type 1 diabetes, which accounts for around 15 % of the total diabetic population, is an autoimmune disease of the pancreas in which the insulin-producing β-cells of the pancreas are selectively destroyed, resulting in an absolute insulin deficiency. The condition arises in genetically susceptible individuals exposed to undefined environmental insult(s) (possibly viral infection) early in life. It usually becomes clinically evident and therefore diagnosed during late childhood, with peak incidence between 11 and 13 years of age, although the autoimmune-mediated β-cell destruction begins many years earlier. There is currently no cure and type 1 diabetics have an absolute life-long requirement for daily insulin injections to survive. Type 2 diabetes This is the most common form of diabetes: around 85 % of the diabetic population has type 2 diabetes. The primary prob Continue reading >>

Diabetic Emergencies: Ketoacidosis

Diabetic Emergencies: Ketoacidosis

Our flight crew was dispatched to a small local hospital for a 58 year old male with an altered level of consciousness and elevated blood sugar. His son had found him unresponsive on the couch and called EMS for help. While en route to the local hospital a bedside glucose was checked reporting "high." His respiratory rate was 36 and his heart rate was in the 150s. He was slow to respond, but woke to verbal commands and was orientated to person only. At the hospital, another bedside glucose returned "high" and he received 10 units of insulin IV. A foley catheter was inserted draining 1400 ml of urine immediately. The flight crew arrived to find our patient’s LOC without change. Pupils were equal at 3 mm, and sluggish in response to light. Mucous membranes were dry. He had a respiratory rate of 36 breaths per minute and shallow. His lung sounds were clear and equal bilateral. An incision at his right shoulder from a surgery one week ago appeared well healed with no redness or signs of infection. Lab results available at the time of transport were limited to: Glucose — 799 mg/dl CO2 — 3.1 mEq/L ph — 6.77 (venous) Fluid intake — 800 ml 0.9% sodium chloride Urine output — 1400 ml The only medication given so far was regular insulin 10 units IV. Definition: Diabetes mellitus is a chronic disease comprised of a group of hyperglycemic disorders, characterized by high serum glucose, and disturbances of carbohydrate and lipid metabolism. Type 1 The patient is usually less than 40 years old at the time of onset. Peak age of onset is 10 to 14 years old. They are typically lean and ketosis prone. Plasma insulin levels are low to absent. Type 2 This patient is usually 45 to 65 years old at the time of onset. These patients are typically overweight, with normal to high ins Continue reading >>

Acid-base Physiology

Acid-base Physiology

An outline of management is presented: this should be tailored to individual circumstances. Management of DKA has passed through 3 stages in the last 100 years: Stage 1: Preinsulin era (Feature: mortality of 100%) Stage 2: High dose insulin regime (Feature: mortality down to 10% but metabolic complications due to the treatment) Stage 3 (the present): Low dose insulin regime (Feature: low mortality) Mortality with the low dose insulin regime is down to about 2 to 5% overall. In older patients with DKA precipitated by a major medical illness (eg acute pancreatitis, myocardial infarction, septicaemia), the mortality rate is still high due to the severity of the precipitating problem. Restore normal carbohydrate and lipid metabolism Management can be considered in terms of emergency and routine components. Protect by intubation with a cuffed tube if patient is significantly obtunded. Consider placing a nasogastric tube in all patients. Intubation may be necessary for airway protection or ventilation (eg if aspiration, coma, pneumonia, pulmonary oedema, acute pancreatitis and ARDS) but this is not common. Maintain compensatory hyperventilation in intubated patients Patients with metabolic acidosis (eg severe DKA) have marked hyperventilation (ie respiratory compensation, Kussmaul respirations) and typically low arterial pCO2 levels. If intubated and ventilated, ventilatory parameters (tidal volume and rate) need to be set to continue a high minute ventilation. If this is not done and pCO2 is inappropriately high, a severe acidaemia and consequent severe cardiovascular collapse may occur This is a particular problem in all situations where a patient with a compensated metabolic acidosis is intubated and ventilated. The rule of thumb is to aim for a pCO2 level of 1.5 times th Continue reading >>

What Is Kussmaul Breathing?

What Is Kussmaul Breathing?

People with diabetes mellitus, especially type 1 diabetes and rarely in type 2 diabetes, tend to burn fatty acids which brings changes in the breathing patterns. Apart from diabetes, other forms of metabolic acidosis also result in Kussmaul breathing . The breathing is usually involuntary, in an effort by the body to get rid of unnecessary acids. Read on to find out more about Kussmaul breathing . In type 1 diabetics, when the body runs out of insulin or is not provided with enough insulin (especially during the times of excessive physical activity), it starts to burn fatty acids to produce energy. Burning fatty acids produces ketones as waste products which are released into the blood stream increasing the acidity of the blood (diabetic ketoacidosis). If the kidneys fail to discharge this excess acids through urine or if there is too many of acid units than the kidneys can process, the only way the body can reduce acidity is through respiration. In the beginning the breathing pattern is usually rapid, short, and shallow, and as the acidosis progresses it becomes slow, deep, and long to exhale the acids. This is similar to hyperventilation with characteristics of air hunger and results in a decrease in partial pressure of carbon dioxide and bicarbonate levels in the blood. The reason behind this abnormal breathing pattern is differentiated by the presence of high blood sugar levels from other forms of ketoacidosis. The presence of high blood sugar levels indicates diabetic ketoacidosis. In less severe cases of metabolic acidosis or diabetic ketoacidosis, the breathing usually comes back to normal when the blood’s composition becomes normal. Severe cases of acidosis along with this type of breathing can lead to coma. If you find yourself or someone you know suffering f Continue reading >>

Understanding And Treating Diabetic Ketoacidosis

Understanding And Treating Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a serious metabolic disorder that can occur in animals with diabetes mellitus (DM).1,2 Veterinary technicians play an integral role in managing and treating patients with this life-threatening condition. In addition to recognizing the clinical signs of this disorder and evaluating the patient's response to therapy, technicians should understand how this disorder occurs. DM is caused by a relative or absolute lack of insulin production by the pancreatic b-cells or by inactivity or loss of insulin receptors, which are usually found on membranes of skeletal muscle, fat, and liver cells.1,3 In dogs and cats, DM is classified as either insulin-dependent (the body is unable to produce sufficient insulin) or non-insulin-dependent (the body produces insulin, but the tissues in the body are resistant to the insulin).4 Most dogs and cats that develop DKA have an insulin deficiency. Insulin has many functions, including the enhancement of glucose uptake by the cells for energy.1 Without insulin, the cells cannot access glucose, thereby causing them to undergo starvation.2 The unused glucose remains in the circulation, resulting in hyperglycemia. To provide cells with an alternative energy source, the body breaks down adipocytes, releasing free fatty acids (FFAs) into the bloodstream. The liver subsequently converts FFAs to triglycerides and ketone bodies. These ketone bodies (i.e., acetone, acetoacetic acid, b-hydroxybutyric acid) can be used as energy by the tissues when there is a lack of glucose or nutritional intake.1,2 The breakdown of fat, combined with the body's inability to use glucose, causes many pets with diabetes to present with weight loss, despite having a ravenous appetite. If diabetes is undiagnosed or uncontrolled, a series of metab Continue reading >>

Kussmaul Breathing

Kussmaul Breathing

Also found in: Dictionary, Thesaurus, Legal, Encyclopedia, Wikipedia. Related to Kussmaul breathing: Biot's breathing Kussmaul breathing abnormally deep, very rapid sighing respirations characteristic of diabetic ketoacidosis. Kussmaul breathing Air hunger Clinical medicine Rapid, deep respiration 2º to stimulation of the respiratory center of the brain triggered by ↓ pH, normal during exercise, and common in Pts with severe metabolic acidosis–eg, DKA. See Metabolic acidosis, Diabetes. breathing (breth'ing) abdominodiaphragmatic breathing A controlled method of breathing in which the diaphragm is used for inspiration and the abdominal muscles for expiration. This technique improves exertional dyspnea, esp. in patients with chronic pulmonary disease. Synonym: diaphragmatic breathing apneustic breathing An abnormal breathing pattern marked by prolonged inspiration followed by an inspiratory pause. This is usually associated with brainstem injuries. assisted breathing Any technique that improves respiration. Such breathing includes the provision of supplemental oxygen, bag-valve-mask ventilation, noninvasive ventilation, mechanical ventilation, and mouth-to-mouth ventilation. asthmatic breathing Harsh breathing with prolonged wheezing heard throughout expiration. ataxic breathing An irregular, uncoordinated breathing pattern common in infants. belly breathing Abdominal respiration. Biot breathing See: Biot breathing bronchial breathing Bronchial sounds. Cheyne-Stokes breathing See: Cheyne-Stokes respiration continuous positive-pressure breathing A method of mechanically assisted pulmonary inflation. A device administers air or oxygen to the lungs under a continuous pressure that is always greater than zero. Synonym: continuous positive-pressure ventilation diaphragmat Continue reading >>

Kussmaul Breathing

Kussmaul Breathing

Not to be confused with Kussmaul's sign. Graph showing the Kussmaul breathing and other pathological breathing patterns. Kussmaul breathing is a deep and labored breathing pattern often associated with severe metabolic acidosis, particularly diabetic ketoacidosis (DKA) but also kidney failure. It is a form of hyperventilation, which is any breathing pattern that reduces carbon dioxide in the blood due to increased rate or depth of respiration. In metabolic acidosis, breathing is first rapid and shallow[1] but as acidosis worsens, breathing gradually becomes deep, labored and gasping. It is this latter type of breathing pattern that is referred to as Kussmaul breathing. Terminology[edit] Adolph Kussmaul, who introduced the term, referred to breathing when metabolic acidosis was sufficiently severe for the respiratory rate to be abnormal or reduced.[2] This definition is also followed by several other sources,[3][4] including for instance Merriam-Webster, which defines Kussmaul breathing as "abnormally slow deep respiration characteristic of air hunger and occurring especially in acidotic states".[5] Other sources, however, use the term Kussmaul respiration also when acidosis is less severe, in which case breathing is rapid.[4][6] Note that Kussmaul breathing occurs only in advanced stages of acidosis, and is fairly rarely reached. In less severe cases of acidosis, rapid, shallow breathing is seen. Kussmaul breathing is a kind of very deep, gasping, desperate breathing. Occasionally, medical literature refers to any abnormal breathing pattern in acidosis as Kussmaul breathing; however, this is inaccurate. History[edit] Kussmaul breathing is named for Adolph Kussmaul,[2] the 19th century German doctor who first noted it among patients with advanced diabetes mellitus. Kussm Continue reading >>

Kussmaul Breathing

Kussmaul Breathing

What is Kussmaul Breathing? Kussmaul Breathing is the term given to a condition in which the patient builds up an extremely deep and difficult breathing pattern. This is seen mostly in individuals who are diabetic and have severe forms of metabolic acidosis, particularly diabetic ketoacidosis with kidney dysfunction. Kussmaul Breathing can likewise be clarified as a type of hyperventilation which is a condition in which an individual breathes in such a deep pattern, to the point that the level of carbon dioxide reduces in the blood, which is seen for the most part in metabolic acidosis where the breathing turns out to be more quick and shallow and as the condition exacerbates the breathing gets to be distinctly shallow and profound and it looks as though the individual is virtually gasping for breath. This kind of breathing in which the individual is essentially gasping for air is what is named as Kussmaul Breathing. Kussmaul’s Respiration There are diverse medical conditions that can influence the basic/acidic balance in your body, which means your body can turn out to be more basic or acidic. At the point when a man is acidotic, that is to say they are experiencing a pathological process (known as acidosis) that prompts to acidemia, an abnormal low pH of the blood, they may experience Kussmaul’s respiration. Kussmaul’s respiration, as German doctor Adolph Kussmaul himself portrayed, is in fact profound, slow, and labored breathing, which we now know is because of serious acidemia coming from metabolic acidosis. Nonetheless, these days, it is now and again used to portray shallow and rapid breathing examples in instances of less severe acidemia too. Reasons for this breathing pattern happening All things considered, what do you take in? Oxygen, isn’t that so? W Continue reading >>

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