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Why Do You Vomit In Dka?

Physiology Of Vomiting

Physiology Of Vomiting

"At least after death you're not nauseous." Woody Allen in Sleeper Vomiting is the forceful expulsion of contents of the stomach and often, the proximal small intestine. It is a manifestation of a large number of conditions, many of which are not primary disorders of the gastrointestinal tract. Regardless of cause, vomiting can have serious consequences, including acid-base derangments, volume and electrolyte depletion, malnutrition and aspiration pneumonia. The Act of Vomiting Vomiting is usually experienced as the finale in a series of three events, which everyone reading this has experienced: Nausea is an unpleasant and difficult to describe psychic experience in humans and probably animals. Physiologically, nausea is typically associated with decreased gastric motility and increased tone in the small intestine. Additionally, there is often reverse peristalsis in the proximal small intestine. Retching ("dry heaves") refers to spasmodic respiratory movements conducted with a closed glottis. While this is occurring, the antrum of the stomach contracts and the fundus and cardia relax. Studies with cats have shown that during retching there is repeated herniation of the abdominal esophagus and cardia into the thoracic cavity due to the negative pressure engendered by inspiratory efforts with a closed glottis. Emesis or vomition is when gastric and often small intestinal contents are propelled up to and out of the mouth. It results from a highly coordinated series of events that could be described as the following series of steps (don't practice these in public): A deep breath is taken, the glottis is closed and the larynx is raised to open the upper esophageal sphincter. Also, the soft palate is elevated to close off the posterior nares. The diaphragm is contracted sharp Continue reading >>

Sick Day Management Tips When Your Child Has Type 1 Diabetes

Sick Day Management Tips When Your Child Has Type 1 Diabetes

Having a sick child can be challenging—getting time off work and securing a last-minute doctor's appointment isn't always easy. But when your sick child also happens to have type 1 diabetes, it presents a separate set of complications relating to insulin and blood glucose (blood sugar) management. This article covers some important considerations to keep in mind the next time your child with type 1 diabetes feels under the weather. Checking Blood Glucose and Ketones Even the most common ailments, such as a cold or flu, can cause your child's blood glucose levels to rise. Plus, some over-the-counter medications can cause blood glucose levels to increase even more. Complicating matters, your child's blood glucose levels may actually drop too low if he or she is vomiting or has stopped eating. You just can't be certain how an illness will affect your child's blood glucose—that's why it's important to check their levels more often than you normally would. A general guideline to shoot for is to check their blood glucose every 2 to 3 hours, but remember—that's a guideline. Your child may require more or fewer checks, depending on your health care professional's recommendations. In addition to checking blood glucose levels, you also need to check for the presence of ketones in the urine. In people with type 1 diabetes, common illnesses can lead to diabetic ketoacidosis, a condition characterized by acidic blood caused by the release of too many ketones. Ketones are released when your body doesn't have enough insulin, so it's important to check your child's urine regularly (usually every 4 hours) until there are no ketones detected. If ketones are still present, that's a sign that your child needs more insulin. There are 2 ways to check ketones: using urine ketone strips Continue reading >>

Diabetic Emergencies, Part 5: Dka Case Studies

Diabetic Emergencies, Part 5: Dka Case Studies

Case Study 1 A 32-year-old male with type 1 diabetes since the age of 14 years was taken to the emergency room because of drowsiness, fever, cough, diffuse abdominal pain, and vomiting. Fever and cough started 2 days ago and the patient could not eat or drink water. He has been treated with an intensive insulin regimen (insulin glargine 24 IU at bedtime and a rapid-acting insulin analog before each meal). On examination he was tachypneic, his temperature was 39° C (102.2° F), pulse rate 104 beats per minute, respiratory rate 24 breaths per minute, supine blood pressure 100/70 mmHg; he also had dry mucous membranes, poor skin turgor, and rales in the right lower chest. He was slightly confused. Rapid hematology and biochemical tests showed hematocrit 48%, hemoglobin 14.3 g/dl (143 g/L), white blood cell count 18,000/ μ l, glucose 450 mg/dl (25.0 mmol/L), urea 60 mg/dl (10.2 mmol/L), creatinine 1.4 mg/dl (123.7 μ mol/L), Na+ 152 mEq/L, K+ 5.3 mEq/L, PO4 3−2.3 mEq/L (0.74 mmol/L), and Cl− 110 mmol/L. Arterial pH was 6.9, PO 2 95 mmHg, PCO 2 28 mmHg, HCO 3−9 mEq/L, and O 2 sat 98%. The result of the strip for ketone bodies in urine was strongly positive and the concentration of β-OHB in serum was 3.5 mmol/L. Urinalysis showed glucose 800 mg/dl and specific gravity 1030. What is your diagnosis? The patient has hyperglycemia, ketosis, and metabolic acidosis. Therefore, he has DKA. In addition, because of the pre-existing fever, cough, localized rales on auscultation and high white blood cell count, a respiratory tract infection should be considered. The patient is also dehydrated and has impaired renal function. Do you need more tests to confirm the diagnosis? Determination of the effective serum osmolality and anion gap should be performed in all patients presenti Continue reading >>

Gastroparesis: A Complication Of Diabetes

Gastroparesis: A Complication Of Diabetes

"Gastro" means stomach and "paresis" means impairment or paralysis. Diabetic gastropathy is a term for the spectrum of neuromuscular abnormalities of the stomach caused by diabetes. The abnormalities include gastric-dysrhythmias, antral hypomotility, incoordination of antroduodenal contractions and gastroparesis. Quick Stomach Anatomy Lesson The stomach is a neuromusclar organ that receives the food we ingest, mixes the food with acid and pepsin, and empties the nutriment suspension into the small intestine for absorption. The proximal stomach or fundus relaxes in order to receive the swallowed food (that's called receptive relaxation). The body and antrum mix and empty the food via recurrent gastric peristalic waves. The peristaltic contractions are paced by neoelectrical events called pacesetter potentials or slow waves. When gastric motility is normal, the postprandial (after eating) period is associated with pleasant epigastric sensations. Gastric motility disorders or gastroparesis presents with unpleasant, but non-specific postprandial symptoms: upper abdominal bloating, distention, discomfort, early satiety, nausea, and vomiting. If the vomitus contains undigested food, then gastroparesis is very likely to be present. Fluctuating, difficult-to-predict glucose levels may also reflect the presence of gastroparesis. Diabetes and the GI Tract The motility of your GI tract, which we were just speaking of, is controlled by an outer sleeve of muscles that surrounds your GI tract. They are controlled by a complex nervous system. Diabetes can damage these nerves, and it is this neurological long-term complication of diabetes that can lead to gastrointestinal disorders. How do we know this is the case? First, many of the people with gastroparesis have long-standing diabete Continue reading >>

Vomiting In Diabetic Cats

Vomiting In Diabetic Cats

It’s not difficult to recognize the more common diabetes symptoms in cats. They drink a lot of water, urinate more frequently and lose weight. Treatment of diabetes involves regular injections of insulin to keep blood glucose levels within normal limits. Vomiting isn’t one of the most common feline symptoms of this disease. Having said that, if a cat is being treated for feline diabetes, vomiting is definitely something to watch out for. It can indicate that their blood glucose is not being well controlled, and they may be developing diabetic ketoacidosis. This is a potentially fatal condition that needs urgent veterinary treatment. However, if a diabetic cat starts throwing up, it doesn’t necessarily mean that their diabetes is worsening. Other symptoms of diabetic ketoacidosis to look for are increased thirst, loss of appetite and extreme lethargy. Another reason for diabetic vomiting in cats is pancreatitis. This condition can be hard to diagnose in our feline family members but should always be considered when cat vomiting in a diabetic pet becomes a problem. Some veterinarians believe that up to one half of all cases of diabetes in cats are accompanied by a low grade chronic inflammation of the pancreas. When they have a flare up, it can reduce their appetite and make them vomit. They need to be closely monitored until they recover because the change in their food intake will affect the amount of insulin they need. Don’t forget that there are many other cat vomiting causes that are totally unrelated to diabetes. Some examples include gastroenteritis, kidney disease and inflammatory bowel disease. Because a diabetic cat has an underlying chronic medical condition, any illness will need a thorough investigation including comprehensive blood tests and possibly Continue reading >>

Diabetes With Ketone Bodies In Dogs

Diabetes With Ketone Bodies In Dogs

Studies show that female dogs (particularly non-spayed) are more prone to DKA, as are older canines. Diabetic ketoacidosis is best classified through the presence of ketones that exist in the liver, which are directly correlated to the lack of insulin being produced in the body. This is a very serious complication, requiring immediate veterinary intervention. Although a number of dogs can be affected mildly, the majority are very ill. Some dogs will not recover despite treatment, and concurrent disease has been documented in 70% of canines diagnosed with DKA. Diabetes with ketone bodies is also described in veterinary terms as diabetic ketoacidosis or DKA. It is a severe complication of diabetes mellitus. Excess ketone bodies result in acidosis and electrolyte abnormalities, which can lead to a crisis situation for your dog. If left in an untreated state, this condition can and will be fatal. Some dogs who are suffering from diabetic ketoacidosis may present as systemically well. Others will show severe illness. Symptoms may be seen as listed below: Change in appetite (either increase or decrease) Increased thirst Frequent urination Vomiting Abdominal pain Mental dullness Coughing Fatigue or weakness Weight loss Sometimes sweet smelling breath is evident Slow, deep respiration. There may also be other symptoms present that accompany diseases that can trigger DKA, such as hypothyroidism or Cushing’s disease. While some dogs may live fairly normal lives with this condition before it is diagnosed, most canines who become sick will do so within a week of the start of the illness. There are four influences that can bring on DKA: Fasting Insulin deficiency as a result of unknown and untreated diabetes, or insulin deficiency due to an underlying disease that in turn exacerba Continue reading >>

Alcoholic Ketoacidosis

Alcoholic Ketoacidosis

What is alcoholic ketoacidosis? Cells need glucose (sugar) and insulin to function properly. Glucose comes from the food you eat, and insulin is produced by the pancreas. When you drink alcohol, your pancreas may stop producing insulin for a short time. Without insulin, your cells won’t be able to use the glucose you consume for energy. To get the energy you need, your body will start to burn fat. When your body burns fat for energy, byproducts known as ketone bodies are produced. If your body is not producing insulin, ketone bodies will begin to build up in your bloodstream. This buildup of ketones can produce a life-threatening condition known as ketoacidosis. Ketoacidosis, or metabolic acidosis, occurs when you ingest something that is metabolized or turned into an acid. This condition has a number of causes, including: shock kidney disease abnormal metabolism In addition to general ketoacidosis, there are several specific types. These types include: alcoholic ketoacidosis, which is caused by excessive consumption of alcohol diabetic ketoacidosis (DKA), which mostly develops in people with type 1 diabetes starvation ketoacidosis, which occurs most often in women who are pregnant, in their third trimester, and experiencing excessive vomiting Each of these situations increases the amount of acid in the system. They can also reduce the amount of insulin your body produces, leading to the breakdown of fat cells and the production of ketones. Alcoholic ketoacidosis can develop when you drink excessive amounts of alcohol for a long period of time. Excessive alcohol consumption often causes malnourishment (not enough nutrients for the body to function well). People who drink large quantities of alcohol may not eat regularly. They may also vomit as a result of drinking too Continue reading >>

How Does Diabetic Ketoacidosis Cause Vomiting?

How Does Diabetic Ketoacidosis Cause Vomiting?

DKA can occur in people who are newly diagnosed with type 1 diabetes and have had ketones building up in their blood prior to the start of treatment. It can also occur in people already diagnosed with type 1 diabetes that have missed an insulin dose, have an infection, or have suffered a traumatic event or injury. With type 1 diabetes, the pancreas is unable to make the hormone insulin, which the body’s cells need in order to take in glucose from the blood. In the case of type 2 diabetes, the pancreas is unable to make sufficient amounts of insulin in order to take in glucose from the blood. Glucose, a simple sugar we get from the foods we eat, is necessary for making the energy our cells need to function. People with diabetes can’t get glucose into their cells, so their bodies look for alternative energy sources. Meanwhile, glucose builds up in the bloodstream, and by the time DKA occurs, blood glucose levels are often greater than 22 mmol/L (400 mg/dL) while insulin levels are very low. Since glucose isn’t available for cells to use, fat from fat cells is broken down for energy instead, releasing ketones. Ketones accumulate in the blood, causing it to become more acidic. As a result, many of the enzymes that control the body’s metabolic processes aren’t able to function as well. A higher level of ketones also affects levels of sugar and electrolytes in the body. As ketones accumulate in the blood, more ketones will be passed in the urine, taking sodium and potassium salts out with them. Over time, levels of sodium and potassium salts in the body become depleted, which can cause nausea and vomiting. The result is a vicious cycle. The most important prevention strategies are to monitor blood glucose levels routinely, keep blood glucose levels controlled (e.g., Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Introduction Diabetic ketoacidosis (DKA) is a dangerous complication of diabetes caused by a lack of insulin in the body. Diabetic ketoacidosis occurs when the body is unable to use blood sugar (glucose) because there isn't enough insulin. Instead, it breaks down fat as an alternative source of fuel. This causes a build-up of a by-product called ketones. Most cases of diabetic ketoacidosis occur in people with type 1 diabetes, although it can also be a complication of type 2 diabetes. Symptoms of diabetic ketoacidosis include: passing large amounts of urine feeling very thirsty vomiting abdominal pain Seek immediate medical assistance if you have any of these symptoms and your blood sugar levels are high. Read more about the symptoms of diabetic ketoacidosis. Who is affected by diabetic ketoacidosis? Diabetic ketoacidosis is a relatively common complication in people with diabetes, particularly children and younger adults who have type 1 diabetes. Younger children under four years of age are thought to be most at risk. In about 1 in 4 cases, diabetic ketoacidosis develops in people who were previously unaware they had type 1 diabetes. Diabetic ketoacidosis accounts for around half of all diabetes-related hospital admissions in people with type 1 diabetes. Diabetic ketoacidosis triggers These include: infections and other illnesses not keeping up with recommended insulin injections Read more about potential causes of diabetic ketoacidosis. Diagnosing diabetic ketoacidosis This is a relatively straightforward process. Blood tests can be used to check your glucose levels and any chemical imbalances, such as low levels of potassium. Urine tests can be used to estimate the number of ketones in your body. Blood and urine tests can also be used to check for an underlying infec Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Initial Evaluation Initial evaluation of patients with DKA includes diagnosis and treatment of precipitating factors (Table 14–18). The most common precipitating factor is infection, followed by noncompliance with insulin therapy.3 While insulin pump therapy has been implicated as a risk factor for DKA in the past, most recent studies show that with proper education and practice using the pump, the frequency of DKA is the same for patients on pump and injection therapy.19 Common causes by frequency Other causes Selected drugs that may contribute to diabetic ketoacidosis Infection, particularly pneumonia, urinary tract infection, and sepsis4 Inadequate insulin treatment or noncompliance4 New-onset diabetes4 Cardiovascular disease, particularly myocardial infarction5 Acanthosis nigricans6 Acromegaly7 Arterial thrombosis, including mesenteric and iliac5 Cerebrovascular accident5 Hemochromatosis8 Hyperthyroidism9 Pancreatitis10 Pregnancy11 Atypical antipsychotic agents12 Corticosteroids13 FK50614 Glucagon15 Interferon16 Sympathomimetic agents including albuterol (Ventolin), dopamine (Intropin), dobutamine (Dobutrex), terbutaline (Bricanyl),17 and ritodrine (Yutopar)18 DIFFERENTIAL DIAGNOSIS Three key features of diabetic acidosis are hyperglycemia, ketosis, and acidosis. The conditions that cause these metabolic abnormalities overlap. The primary differential diagnosis for hyperglycemia is hyperosmolar hyperglycemic state (Table 23,20), which is discussed in the Stoner article21 on page 1723 of this issue. Common problems that produce ketosis include alcoholism and starvation. Metabolic states in which acidosis is predominant include lactic acidosis and ingestion of drugs such as salicylates and methanol. Abdominal pain may be a symptom of ketoacidosis or part of the inci Continue reading >>

Feline Diabetes

Feline Diabetes

Insulin injections are the preferred method of managing diabetes in cats. Figure 1: To administer an injection, pull the loose skin between the shoulder blades with one hand. With the other hand, insert the needle directly into the indentation made by holding up the skin, draw back on the plunger slightly, and if no blood appears in the syringe, inject gently. Tips for Treatment 1. You can do it! Treating your cat may sound difficult, but for most owners it soon becomes routine. 2. Work very closely with your veterinarian to get the best results for your cat. 3. Once your cat has been diagnosed, it's best to start insulin therapy as soon as possible. 4. Home glucose monitoring can be very helpful. 5. Tracking your cat's water intake, activity level, appetite, and weight can be beneficial. 6. A low carbohydrate diet helps diabetic cats maintain proper glucose levels. 7. With careful treatment, your cat's diabetes may well go into remission. 8. If your cat shows signs of hypoglycemia (lethargy, weakness, tremors, seizures, vomiting) apply honey, a glucose solution, or dextrose gel to the gums and immediately contact a veterinarian. Possible Complications Insulin therapy lowers blood glucose, possibly to dangerously low levels. Signs of hypoglycemia include weakness, lethargy, vomiting, lack of coordination, seizures, and coma. Hypoglycemia can be fatal if left untreated, so any diabetic cat that shows any of these signs should be offered its regular food immediately. If the cat does not eat voluntarily, it should be given oral glucose in the form of honey, corn syrup, or proprietary dextrose gels (available at most pharmacies) and brought to a veterinarian immediately. It is important, however, that owners not attempt to force fingers, food, or fluids into the mouth of a Continue reading >>

Diabetes: Problem Solving

Diabetes: Problem Solving

Adults Living with Diabetes It is important to know what to do if your blood glucose is outside your target range. See the guidelines below. Low Blood Glucose (Hypoglycemia) Low blood glucose, also called hypoglycemia, is a true emergency. It can happen suddenly and progress rapidly to a coma. It is important to know how to prevent, recognize and treat low blood glucose. Low blood glucose is a reading under 70 mg/dL with or without symptoms, or between 70 - 100 mg/dL with symptoms. Symptoms of low blood glucose: Early symptoms Shakiness Sweaty, cold or clammy skin Dizziness or lightheadedness Anxiousness or nervousness Fast heart beat Hunger Headache Irritability Weakness or fatigue Vision changes Late symptoms Tingling around the mouth Mental dullness Personality changes Seeing spots in front of your eyes or vision changes You may have low blood glucose even if you do not have all of these symptoms. If you have symptoms of low blood glucose, do a test right away. If you can not test, treat as if you have low blood glucose. To treat low blood glucose, follow the 15/15 Rule below. Low Blood Glucose Treatment: 15/15 Rule Treat low blood glucose by taking one serving of fast-acting sugar from the following list (each serving below contains about 15 grams of fast-acting sugar): 3 square or 4 round glucose tabs 1/2 cup (4 oz) fruit juice 1/2 cup (4 oz) of regular (not diet) soda 1 Tablespoon of honey or sugar 5 small sugar cubes 8 Lifesavers® candies 2 Tablespoons of raisins (mini box size) 1 cup of non-fat milk 15 minutes after treating the symptoms, test your blood glucose: If your blood glucose is still less than 70 mg/dL, or between 70 - 100 mg/dL with symptoms, take another 15-gram serving of fast-acting sugar from the list above. Repeat until your blood glucose is ove 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 >>

Hyperglycemia In Diabetes

Hyperglycemia In Diabetes

Print Overview High blood sugar (hyperglycemia) affects people who have diabetes. Several factors can contribute to hyperglycemia in people with diabetes, including food and physical activity choices, illness, nondiabetes medications, or skipping or not taking enough glucose-lowering medication. It's important to treat hyperglycemia, because if left untreated, hyperglycemia can become severe and lead to serious complications requiring emergency care, such as a diabetic coma. In the long term, persistent hyperglycemia, even if not severe, can lead to complications affecting your eyes, kidneys, nerves and heart. Symptoms Hyperglycemia doesn't cause symptoms until glucose values are significantly elevated — above 200 milligrams per deciliter (mg/dL), or 11 millimoles per liter (mmol/L). Symptoms of hyperglycemia develop slowly over several days or weeks. The longer blood sugar levels stay high, the more serious the symptoms become. However, some people who've had type 2 diabetes for a long time may not show any symptoms despite elevated blood sugars. Early signs and symptoms Recognizing early symptoms of hyperglycemia can help you treat the condition promptly. Watch for: Frequent urination Increased thirst Blurred vision Fatigue Headache Later signs and symptoms If hyperglycemia goes untreated, it can cause toxic acids (ketones) to build up in your blood and urine (ketoacidosis). Signs and symptoms include: Fruity-smelling breath Nausea and vomiting Shortness of breath Dry mouth Weakness Confusion Coma Abdominal pain When to see a doctor Call 911 or emergency medical assistance if: You're sick and can't keep any food or fluids down, and Your blood glucose levels are persistently above 240 mg/dL (13 mmol/L) and you have ketones in your urine Make an appointment with your Continue reading >>

Ketoacidosis

Ketoacidosis

GENERAL ketoacidosis is a high anion gap metabolic acidosis due to an excessive blood concentration of ketone bodies (keto-anions). ketone bodies (acetoacetate, beta-hydroxybutyrate, acetone) are released into the blood from the liver when hepatic lipid metabolism has changed to a state of increased ketogenesis. a relative or absolute insulin deficiency is present in all cases. CAUSES The three major types of ketosis are: (i) Starvation ketosis (ii) Alcoholic ketoacidosis (iii) Diabetic ketoacidosis STARVATION KETOSIS when hepatic glycogen stores are exhausted (eg after 12-24 hours of total fasting), the liver produces ketones to provide an energy substrate for peripheral tissues. ketoacidosis can appear after an overnight fast but it typically requires 3 to 14 days of starvation to reach maximal severity. typical keto-anion levels are only 1 to 2 mmol/l and this will usually not alter the anion gap. the acidosis even with quite prolonged fasting is only ever of mild to moderate severity with keto-anion levels up to a maximum of 3 to 5 mmol/l and plasma pH down to 7.3. ketone bodies also stimulate some insulin release from the islets. patients are usually not diabetic. ALCOHOLIC KETOSIS Presentation a chronic alcoholic who has a binge, then stops drinking and has little or no oral food intake for a few days (ethanol and fasting) volume depletion is common and this can result in increased levels of counter regulatory hormones (eg glucagon) levels of free fatty acids (FFA) can be high (eg up to 3.5mM) providing plenty of substrate for the altered hepatic lipid metabolism to produce plenty of ketoanions GI symptoms are common (eg nausea, vomiting, abdominal pain, haematemesis, melaena) acidaemia may be severe (eg pH down to 7.0) plasma glucose may be depressed or normal or Continue reading >>

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