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 >>
Symptoms Of Kussmaul Respirations: Its Causes And Treatment
Kussmaul respiration is an abnormal pattern of respiration characterized by deep and hurried breathing. It is one of the most distinctive feature of diabetic ketoacidosis, a serious metabolic complication of diabetes with associated dysfunction of kidneys. Kussmaul breathing causes low level of carbon dioxide in the blood. When the acid content in the blood increases as in metabolic acidosis, diabetic acidosis, or kidney failure, there is increased desire by the patient to breathe deep and rapidly. As a result carbon dioxide saturation in blood decreases. In the beginning, it is shallow and rapid respiration, however, as the condition worsens, it leads to rapid and fast breathing. The patient seems to be gasping for air. This type of abnormal breathing is called Kussmaul respiration. What Causes Kussmaul Respirations? Kussmaul breathing is a condition which results from low level of carbon dioxide in blood. This abnormal form of respiration is commonly seen in people having diabetic ketoacidosis. Kussmaul respiration is deep and fast breathing. Deep breathing and rapid exhalation causes low level of carbon dioxide in the blood leading to hyperventilation. Following conditions can cause kussmaul respiration. Diabetic ketoacidosis: This condition occurs in people suffering from type 1 and type 2 diabetes. It occurs when there is absolute insulin deficiency as in type 1 diabetes or among people with uncontrolled diabetes as in type 2 diabetes. Deficiency of insulin hormone hampers utilization of glucose as an energy source for cellular activity of the muscles and tissues. Body has to rely on fat and protein for energy source instead of glucose, although there is increased circulating glucose in the blood. Breakdown of fat and protein causes release of waste products in the Continue reading >>
Diabetic Ketoacidosis And Hyperglycemic Hyperosmolar Syndrome
In Brief Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic syndrome (HHS) are two acute complications of diabetes that can result in increased morbidity and mortality if not efficiently and effectively treated. Mortality rates are 2–5% for DKA and 15% for HHS, and mortality is usually a consequence of the underlying precipitating cause(s) rather than a result of the metabolic changes of hyperglycemia. Effective standardized treatment protocols, as well as prompt identification and treatment of the precipitating cause, are important factors affecting outcome. The two most common life-threatening complications of diabetes mellitus include diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar syndrome (HHS). Although there are important differences in their pathogenesis, the basic underlying mechanism for both disorders is a reduction in the net effective concentration of circulating insulin coupled with a concomitant elevation of counterregulatory hormones (glucagon, catecholamines, cortisol, and growth hormone). These hyperglycemic emergencies continue to be important causes of morbidity and mortality among patients with diabetes. DKA is reported to be responsible for more than 100,000 hospital admissions per year in the United States1 and accounts for 4–9% of all hospital discharge summaries among patients with diabetes.1 The incidence of HHS is lower than DKA and accounts for <1% of all primary diabetic admissions.1 Most patients with DKA have type 1 diabetes; however, patients with type 2 diabetes are also at risk during the catabolic stress of acute illness.2 Contrary to popular belief, DKA is more common in adults than in children.1 In community-based studies, more than 40% of African-American patients with DKA were >40 years of age and more than 2 Continue reading >>
Dka Vs Hhs (hhns) Nclex Review
Diabetic ketoacidosis vs hyperglycemic hyperosmolar nonketotic syndrome (HHNS or HHS): What are the differences between these two complications of diabetes mellitus? This NCLEX review will simplify the differences between DKA and HHNS and give you a video lecture that easily explains their differences. Many students get these two complications confused due to their similarities, but there are major differences between these two complications. After reviewing this NCLEX review, don’t forget to take the quiz on DKA vs HHNS. Lecture on DKA and HHS DKA vs HHNS Diabetic Ketoacidosis Affects mainly Type 1 diabetics Ketones and Acidosis present Hyperglycemia presents >300 mg/dL Variable osmolality Happens Suddenly Causes: no insulin present in the body or illness/infection Seen in young or undiagnosed diabetics Main problems are hyperglycemia, ketones, and acidosis (blood pH <7.35) Clinical signs/symptoms: Kussmaul breathing, fruity breath, abdominal pain Treatment is the same as in HHNS (fluids, electrolyte replacement, and insulin) Watch potassium levels closely when giving insulin and make sure the level is at least 3.3 before administrating. Hyperglycemic Hyperosmolar Nonketotic Syndrome Affects mainly Type 2 diabetics No ketones or acidosis present EXTREME Hyperglycemia (remember heavy-duty hyperglycemia) >600 mg/dL sometimes four digits High Osmolality (more of an issue in HHNS than DKA) Happens Gradually Causes: mainly illness or infection and there is some insulin present which prevents the breakdown of ketones Seen in older adults due to illness or infection Main problems are dehydration & heavy-duty hyperglycemia and hyperosmolarity (because the glucose is so high it makes the blood very concentrated) More likely to have mental status changes due to severe dehydrat Continue reading >>
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 >>
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 >>
Diabetic Ketoacidosis And Patho
pathophysiology ketogenesis due to insulin deficiency leads to increased serum levels of ketones anad ketonuria acetoacetate, beta-hydroxybutyrate; ketone bodies produced by the liver, organic acids that cause metabolic acidosis respiration partially compensates; reduces pCO2, when pH < 7.2, deep rapid respirations (Kussmaul breathing) acetone; minor product of ketogenesis, can smell fruity on breath of ketoacidosis patients elevated anion gap Methanol intoxication Uremic acidosis Diabetic ketoacidosis Paraldehyde ingestions Intoxicants (salicyclate, ethylene glycol, nipride, epinephrine, norepinephrine) Lactic acidosis (drug induced; didanosine, iron, isoniazid, metformin, zidovudine) Ethanol ketoacidosis Severe renal failure starvation Blood glucose regulation (6) 1. When blood glucose levels rise above a set point, 2. the pancreas secretes insulin into the blood. 3. Insulin stimulates liver and muscle cells to make glycogen, dropping blood glucose levels. 4. When glucose levels drop below a set point, 5. the pancreas secretes glucagon into the blood. 6. Glucagon promotes the breakdown of glycogen and the release of glucose into the blood. (The pancreas signals distant cells to regulate levels in the blood = endocrine function.) Insulin and Glucagon (Regulation) (10) 1. High blood glucose 2. Beta cells 3. Insulin 4. Glucose enters cell 5. Blood glucose lowered 6. Low blood glucose 7. Alpha cells 8. Glucagon 9. Liver releases glucose from glycogen 10. Blood glucose raised What is the manifestations (symptoms) of Type 1? (10) 1. Extreme thirst 2. Frequent urination 3. Drowsiness, lethargy 4. Sugar in urine 5. Sudden vision change 6. Increased appetite 7. Sudden weight loss 8. Fruity, sweet, or wine like odor on breath 9. Heavy, laboured breathing 10. Stupor, unconscious Continue reading >>
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 >>
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 >>
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 >>
Diabetic Ketoacidosis And Hyperglycaemic Hyperosmolar State
The hallmark of diabetes is a raised plasma glucose resulting from an absolute or relative lack of insulin action. Untreated, this can lead to two distinct yet overlapping life-threatening emergencies. Near-complete lack of insulin will result in diabetic ketoacidosis, which is therefore more characteristic of type 1 diabetes, whereas partial insulin deficiency will suppress hepatic ketogenesis but not hepatic glucose output, resulting in hyperglycaemia and dehydration, and culminating in the hyperglycaemic hyperosmolar state. Hyperglycaemia is characteristic of diabetic ketoacidosis, particularly in the previously undiagnosed, but it is the acidosis and the associated electrolyte disorders that make this a life-threatening condition. Hyperglycaemia is the dominant feature of the hyperglycaemic hyperosmolar state, causing severe polyuria and fluid loss and leading to cellular dehydration. Progression from uncontrolled diabetes to a metabolic emergency may result from unrecognised diabetes, sometimes aggravated by glucose containing drinks, or metabolic stress due to infection or intercurrent illness and associated with increased levels of counter-regulatory hormones. Since diabetic ketoacidosis and the hyperglycaemic hyperosmolar state have a similar underlying pathophysiology the principles of treatment are similar (but not identical), and the conditions may be considered two extremes of a spectrum of disease, with individual patients often showing aspects of both. Pathogenesis of DKA and HHS Insulin is a powerful anabolic hormone which helps nutrients to enter the cells, where these nutrients can be used either as fuel or as building blocks for cell growth and expansion. The complementary action of insulin is to antagonise the breakdown of fuel stores. Thus, the relea Continue reading >>
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 >>
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 >>
[ketoacidotic Diabetic Metabolic Dysregulation: Pathophysiology, Clinical Aspects, Diagnosis And Therapy].
Abstract When glucose utilisation is impaired due to decreased insulin effect, ketones are produced by the liver from free fatty acids to supply an alternate source of energy. This adaptation may be associated with severe metabolic acidosis and tends to occur in patients with type I (insulin-dependent) diabetes mellitus. In addition, hypovolemia is an almost invariable finding with marked hypoglycemia and is primarily induced by the associated glucosuria. Ketoacidosis stimulates both the central and peripheral chemoreceptors controlling respiration, resulting in alveolar hyperventilation (Kussmaul's respiration). With the ensuing fall in pCO2 the patient tries to raise the extracellular pH. A fruity odor of acetone on the patient's breath sometimes suggests that ketoacidosis is present. The classical triad of symptoms associated with hyperglycemia are polyuria, polydipsia, and weight loss. Circulatory insufficiency with hypotension is not uncommon due to the marked fluid loss and acidemia. In more severely affected patients, neurologic abnormalities may be seen, including lethargy, seizures or coma. Some patients also have marked vomiting and abdominal pain. The history and physical examination may provide important clues to the presence of uncontrolled diabetes mellitus. Once suspected, the diagnosis can be easily confirmed by measuring the plasma glucose concentration. Glucosuria and ketonuria can be semiquantitatively detected with reagent sticks. Blood gas analysis and anion gap give objective information as to the severity of the metabolic acidosis. Therapy must be directed toward each of the metabolic disturbances: hyperosmolality, ketoacidosis, hypovolemia and potassium, and phosphate depletion. The mainstays of therapy are the administration of low-dose insulin Continue reading >>
What Is Kussmaul Breathing?
Kussmaul breathing is a deep, labored breathing pattern that indicates that the body or organs have become too acidic. The body is constantly doing work to maintain an average temperature and neutral blood acidity. To make sure this balance happens; the kidneys and cells rely on bases or buffers, chemical compounds that bind with hydrogen ions. Disruptions to these compounds cause Kussmaul breathing, which is typically associated with conditions that cause metabolic disturbances, such as kidney failure and diabetes. Contents of this article: Kussmaul breathing is a type of hyperventilation that is the lung's emergency response to acidosis. Kussmaul breathing causes a labored, deeper breathing rate. It is most commonly associated with conditions that cause metabolic acidosis, particularly diabetes. Because Kussmaul breathing is a sign of severe metabolic acidosis, which is a life-threatening condition, hospitalization is usually necessary. What is Kussmaul breathing? When the body produces or ingests too much acid; or the kidneys or lungs are failing, blood acid levels increase. If the blood becomes too acidic, acidosis occurs, and the body takes action to restore the imbalance. By using deeper, longer breaths, the lungs can expel more acidic carbon dioxide (C02) than normal. The condition takes its name from Adolph Kussmaul, the German physician who first described the breathing pattern in 1874. Symptoms As a type of hyperventilation, some people describe Kussmaul breathing as panicked breathing, where someone appears to be gasping for breath. The deep, powerful breathing associated with Kussmaul breathing often causes inhalation and exhalation to become more evident and loud. Some compare the sound to exaggerated sighing. Symptoms of acidosis Before the deep and labore Continue reading >>
