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Why Do You Vomit In Dka?

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 >>

Ketones.

Ketones.

Headache. Check. Eyes that weighed at least a pound apiece. Check. Mouth full of sweaters. Check. Looks like they're all here - the symptoms of a high blood sugar. Sitting down to catch up on some emails, I absently fish my meter out of my gym back and lance my fingertip. I hit send, graze against the new infusion set on my left thigh, and see a meter result of 420 mg/dl. "Oh, that is just fantastic." Taking out my pump, I calculated the massive correction bolus and felt the quiet sting of the insulin as it coursed through the infusion set I had placed an hour earlier. Normally when I'm at an elevated blood sugar, I feel lethargic and generally Crumbs Morrone, but this one had a different feel to it entirely. My stomach felt like it was playing host to a hamster wheel, and my headache was blinding. I brought the ketone strips into the bathroom and watched uneasily as the pad on the ketone strip turned a deep purple. Large ketones. I hadn't seen those suckers since my days at Clara Barton Camp. I never, ever have ketones, and I test regularly for them. So where did this come from? My stomach in knots, I wandered back into the living room and filled Chris in on the situation. "I'm high. Like crazy high - 420 mg/dl. And I just tested for ketones. I have large ketones. I feel like complete shit, and my stomach is really nauseous." He rubbed my back. "So what do we do?" "Drink a ton of water and try to flush out the ketones, I guess. If I can't keep the water down, we're off to the emergency room." It dawned on me that I had the process of treating a low blood sugar down to a science, but navigating a serious high was unfamiliar territory. Normally, I just bolus and wait for the numbers to fall, but this high came with an added bonus of ketones. The word "ketones" was enough Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) happens when your blood sugar is high and your insulin level is low. This imbalance in the body causes a build-up of ketones. Ketones are toxic. If DKA isn’t treated, it can lead to diabetic coma and even death. DKA mainly affects people who have type 1 diabetes. But it can also happen with other types of diabetes, including type 2 diabetes and gestational diabetes (during pregnancy). DKA is a very serious condition. If you have diabetes and think you may have DKA, contact your doctor or get to a hospital right away. The first symptoms to appear are usually: frequent urination. The next stage of DKA symptoms include: vomiting (usually more than once) confusion or trouble concentrating a fruity odor on the breath. The main cause of DKA is not enough insulin. A lack of insulin means sugar can’t get into your cells. Your cells need sugar for energy. This causes your body’s glucose levels to rise. To get energy, the body starts to burn fat. This process causes ketones to build up. Ketones can poison the body. High blood glucose levels can also cause you to urinate often. This leads to a lack of fluids in the body (dehydration). DKA can be caused by missing an insulin dose, eating poorly, or feeling stressed. An infection or other illness (such as pneumonia or a urinary tract infection) can also lead to DKA. If you have signs of infection (fever, cough, or sore throat), contact your doctor. You will want to make sure you are getting the right treatment. For some people, DKA may be the first sign that they have diabetes. When you are sick, you need to watch your blood sugar level very closely so that it doesn’t get too high or too low. Ask your doctor what your critical blood sugar level is. Most patients should watch their glucose levels c Continue reading >>

Childhood Ketoacidosis

Childhood 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 one of our health articles more useful. Diabetic ketoacidosis (DKA) is the leading cause of mortality in childhood diabetes.[1]The primary cause of DKA is absolute or relative insulin deficiency: Absolute - eg, previously undiagnosed type 1 diabetes mellitus or a patient with known type 1 diabetes who does not take their insulin. Relative - stress causes a rise in counter-regulatory hormones with relative insulin deficiency. DKA can be fatal The usual causes of death are: Cerebral oedema - associated with 25% mortality (see 'Cerebral odedema', below). Hypokalaemia - which is preventable with good monitoring. Aspiration pneumonia - thus, use of a nasogastric tube in the semi-conscious or unconscious is advised. Deficiency of insulin. Rise in counter-regulatory hormones, including glucagon, cortisol, growth hormone, and catecholamines. Thus, inappropriate gluconeogenesis and liver glycogenolysis occur compounding the hyperglycaemia, which causes hyperosmolarity and ensuing polyuria, dehydration and loss of electrolytes. Accelerated catabolism from lipolysis of adipose tissue leads to increased free fatty acid circulation, which on hepatic oxidation produces the ketone bodies (acetoacetic acid and beta-hydroxybutyric acid) that cause the metabolic acidosis. A vicious circle is usually set up as vomiting usually occurs compounding the stress and dehydration; the cycle can only be broken by providing insulin and fluids; otherwise, severe acidosis occurs and can be fatal. Biochemical criteria The biochemical criteria required for a diagnosis of DKA to be made are 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 >>

Diabetic Ketoacidosis (dka)

Diabetic Ketoacidosis (dka)

Also see Pet Diabetes Wiki: Ketoacidosis A Ketone Primer by an FDMB user What are Ketones? Ketones or ketone bodies (acetone, acetoacetic acid, and beta-hydroxybutyric acid) are waste products of fatty acid breakdown in the body. This is the result of burning fat, rather than glucose, to fuel the body. The body tries to dispose of excess ketones as quickly as possible when they are present in the blood. The kidneys filter out ketones and excrete them into the urine. Should you care about ketones? YES! If they build up, they can lead to very serious energy problems in the body, resulting in diabetic ketoacidosis, a true medical emergency. If the condition is not reversed and other systemic stresses are present, ketones may continue to rise and a condition known as diabetic ketoacidosis (DKA) may occur. This condition can progress very quickly and cause severe illness. It is potentially fatal even when treated. Recognition of DKA and rapid treatment by your veterinarian can save your cat's life. Signs of Diabetic Ketoacidosis (DKA) Drinking excessive amounts of water OR no water Excessive urination Diminished activity Not eating for over 12 hours Vomiting Lethargy and depression Weakness Breathing very fast Dehydration Ketone odor on breath (smells like nail-polish remover or fruit) Causes of Diabetic Ketoacidosis (DKA) Insulin dependent diabetes mellitus Inadequate insulin dosing or production Infection Concurrent diseas that stresses the animal Estrus Medication noncompliance Lethargy and depression Stress Surgery Idiopathic (unknown causes) Risk Factors for DKA Any condition that causes an insulin deficiency History of corticosteroid or beta-blocker administration Diagnosis Laboratory tests performed by your vet are necessary for diagnosis. Depending on how sick your c Continue reading >>

Understanding The Link Between Diabetes And Appetite

Understanding The Link Between Diabetes And Appetite

Why Has My Appetite Changed? One of the odd things about diabetes is that it can cause people to lose their appetite, or conversely, can cause them to feel hungrier than usual. Both extremes are usually a warning sign of some possible issue to your health so it’s important (even if you have not been diagnosed with diabetes) to know about how your appetite can signify a potentially more serious health problem. Loss of Appetite Many people would be delighted to lose their appetite if that made it easier to lose some weight, but when appetite loss is linked to diabetes it can be dangerous. Gastrparesis One possible cause of loss of appetite is gastroparesis, a condition where food moves too slowly through the digestive tract. This happens when over time high blood glucose levels damage the vagus nerve — the nerve that supplies nerve fibers to the pharynx (throat), larynx (voice box), trachea (windpipe), lungs, heart, esophagus, and intestinal tract. When this occurs, the muscles in the gut can no longer move food easily out of the stomach into the small intestine to continue the digestion process. This state is called gastroparesis. As well as loss of appetite, symptoms of gastroparesis include weight loss, heartburn, abdominal bloating, reflux, nausea and vomiting undigested food. Additional symptoms might present as high or low blood glucose levels and stomach spasms. The condition makes blood glucose levels more difficult to control. Ketoacidosis Another diabetes-related condition that can cause appetite loss is diabetic ketoacidosis — a complication that occurs when hyperglycaemia (high blood sugar) goes untreated and high levels of ketones build up in the blood and urine. When your body does not produce enough insulin, the cells are unable to use glucose for fue Continue reading >>

Alcoholic Ketoacidosis

Alcoholic Ketoacidosis

Alcoholic ketoacidosis is a metabolic complication of alcohol use and starvation characterized by hyperketonemia and anion gap metabolic acidosis without significant hyperglycemia. Alcoholic ketoacidosis causes nausea, vomiting, and abdominal pain. Diagnosis is by history and findings of ketoacidosis without hyperglycemia. Treatment is IV saline solution and dextrose infusion. Alcoholic ketoacidosis is attributed to the combined effects of alcohol and starvation on glucose metabolism. Alcohol diminishes hepatic gluconeogenesis and leads to decreased insulin secretion, increased lipolysis, impaired fatty acid oxidation, and subsequent ketogenesis, causing an elevated anion gap metabolic acidosis. Counter-regulatory hormones are increased and may further inhibit insulin secretion. Plasma glucose levels are usually low or normal, but mild hyperglycemia sometimes occurs. Diagnosis requires a high index of suspicion; similar symptoms in an alcoholic patient may result from acute pancreatitis, methanol or ethylene glycol poisoning, or diabetic ketoacidosis (DKA). In patients suspected of having alcoholic ketoacidosis, serum electrolytes (including magnesium), BUN and creatinine, glucose, ketones, amylase, lipase, and plasma osmolality should be measured. Urine should be tested for ketones. Patients who appear significantly ill and those with positive ketones should have arterial blood gas and serum lactate measurement. The absence of hyperglycemia makes DKA improbable. Those with mild hyperglycemia may have underlying diabetes mellitus, which may be recognized by elevated levels of glycosylated Hb (HbA1c). Typical laboratory findings include a high anion gap metabolic acidosis, ketonemia, and low levels of potassium, magnesium, and phosphorus. Detection of acidosis may be com Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a serious problem that can occur in people with diabetes if their body starts to run out of insulin. This causes harmful substances called ketones to build up in the body, which can be life-threatening if not spotted and treated quickly. DKA mainly affects people with type 1 diabetes, but can sometimes occur in people with type 2 diabetes. If you have diabetes, it's important to be aware of the risk and know what to do if DKA occurs. Symptoms of diabetic ketoacidosis Signs of DKA include: needing to pee more than usual being sick breath that smells fruity (like pear drop sweets or nail varnish) deep or fast breathing feeling very tired or sleepy passing out DKA can also cause high blood sugar (hyperglycaemia) and a high level of ketones in your blood or urine, which you can check for using home-testing kits. Symptoms usually develop over 24 hours, but can come on faster. Check your blood sugar and ketone levels Check your blood sugar level if you have symptoms of DKA. If your blood sugar is 11mmol/L or over and you have a blood or urine ketone testing kit, check your ketone level. If you do a blood ketone test: lower than 0.6mmol/L is a normal reading 0.6 to 1.5mmol/L means you're at a slightly increased risk of DKA and should test again in a couple of hours 1.6 to 2.9mmol/L means you're at an increased risk of DKA and should contact your diabetes team or GP as soon as possible 3mmol/L or over means you have a very high risk of DKA and should get medical help immediately If you do a urine ketone test, a result of more than 2+ means there's a high chance you have DKA. When to get medical help Go to your nearest accident and emergency (A&E) department straight away if you think you have DKA, especially if you have a high level of ketones in Continue reading >>

Diabetic Ketoacidosis As First Presentation Of Latent Autoimmune Diabetes In Adult

Diabetic Ketoacidosis As First Presentation Of Latent Autoimmune Diabetes In Adult

Case Reports in Medicine Volume 2015 (2015), Article ID 821397, 3 pages Internal Medicine Department, Texas Tech University Health Sciences Center, Amarillo, TX 79106, USA Academic Editor: Christos D. Lionis Copyright © 2015 Omar Nadhem et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. A 54-year-old white female with hypothyroidism presented with abdominal pain, nausea, vomiting, and diarrhea. She was found to have diabetic ketoacidosis (DKA) and admitted to our hospital for treatment. Laboratory workup revealed positive antiglutamic acid decarboxylase antibodies and subsequently she was diagnosed with latent onset autoimmune diabetes in adult (LADA). She was successfully treated with insulin with clinical and laboratory improvement. Diagnosis of LADA has been based on three criteria as given by The Immunology of Diabetes Society: (1) adult age of onset (>30 years of age); (2) presence of at least one circulating autoantibody (GADA/ICA/IAA/IA-2); and (3) initial insulin independence for the first six months. The importance of this case is the unlikely presentation of LADA. We believe that more research is needed to determine the exact proportion of LADA patients who first present with DKA, since similar cases have only been seen in case reports. Adult patients who are obese and have high blood sugar may deserve screening for LADA, especially in the presence of other autoimmune diseases. Those patients once diagnosed with LADA need extensive diabetic education including potentially serious events such as diabetic ketoacidosis. 1. Introduction Latent autoimmune diabetes in adult (LADA) is an autoimm 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 >>

The Signs, Diagnosis & Types Of Diabetes Mellitus In Cats

The Signs, Diagnosis & Types Of Diabetes Mellitus In Cats

There are certain signs or symptoms which are commonly seen in cats with diabetes mellitus. Unfortunately, these signs also occur in other diseases and conditions. Therefore, laboratory tests are necessary to diagnose diabetes mellitus in cats. The following article includes a discussion of how this diagnosis is made and the types of diabetes found in cats. What are the signs of diabetes mellitus in cats and why do they occur? Depending on how severely insulin production is impaired, there may be few signs of disease, or the signs may be severe. Dogs with diabetes often develop cataracts; cats do not. The most common signs of diabetes are: Increased thirst (polydipsia) and urination (polyuria) Change in appetite Weight loss Change in gait (walking) Decreased activity, weakness, depression Vomiting Increased Thirst and Urination: Because the glucose cannot enter the cells, the glucose levels in the blood become abnormally high (hyperglycemia). The glucose is filtered out by the kidneys and is found in the urine (glucosuria). When it is filtered out, it carries water with it. The animal, then, is losing more water through the urine than normal and has to make up for it by drinking more. Inappropriate Elimination: The increased urination may result in the cat not always urinating in the litter box. This inappropriate urination may be one of the first signs of diabetes in cats. In addition, cats with diabetes can often develop urinary tract infections, which may also result in inappropriate elimination. Change in Appetite: Some diabetic cats eat less, because frankly, they do not feel well. Other cats may have voracious appetites and eat a lot (polyphagia) because their hypothalamus keeps telling them they are hungry. Weight Loss: Because the cat cannot use the calories he Continue reading >>

Ketoacidosis: A Complication Of Diabetes

Ketoacidosis: A Complication Of Diabetes

Diabetic ketoacidosis is a serious condition that can occur as a complication of diabetes. People with diabetic ketoacidosis (DKA) have high blood sugar levels and a build-up of chemicals called ketones in the body that makes the blood more acidic than usual. Diabetic ketoacidosis can develop when there isn’t enough insulin in the body for it to use sugars for energy, so it starts to use fat as a fuel instead. When fat is broken down to make energy, ketones are made in the body as a by-product. Ketones are harmful to the body, and diabetic ketoacidosis can be life-threatening. Fortunately, treatment is available and is usually successful. Symptoms Ketoacidosis usually develops gradually over hours or days. Symptoms of diabetic ketoacidosis may include: excessive thirst; increased urination; tiredness or weakness; a flushed appearance, with hot dry skin; nausea and vomiting; dehydration; restlessness, discomfort and agitation; fruity or acetone smelling breath (like nail polish remover); abdominal pain; deep or rapid breathing; low blood pressure (hypotension) due to dehydration; and confusion and coma. See your doctor as soon as possible or seek emergency treatment if you develop symptoms of ketoacidosis. Who is at risk of diabetic ketoacidosis? Diabetic ketoacidosis usually occurs in people with type 1 diabetes. It rarely affects people with type 2 diabetes. DKA may be the first indication that a person has type 1 diabetes. It can also affect people with known diabetes who are not getting enough insulin to meet their needs, either due to insufficient insulin or increased needs. Ketoacidosis most often happens when people with diabetes: do not get enough insulin due to missed or incorrect doses of insulin or problems with their insulin pump; have an infection or illne Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Also known as: DKA Severe diabetic ketoacidosis is a medical emergency and requires prompt treatment to correct dehydration, electrolyte disturbances and acidosis. It is a complication of insulin dependent Diabetes Mellitus. DKA is the result of marked insulin deficiency, and ketonaemia and ketoacidosis occur approximately 15 days after insulin concentrations are suppressed to fasting levels. Marked insulin suppression occurs on average 4 days after fasting glucose levels reach 30mmol/L. Many cats with DKA have other intercurrent conditions which may precipitate the condition including: infection, pancreatitis or renal insufficiency. Pathophysiology Insulin deficiency leads to increased breakdown of fat that releases fatty acids into the circulation. Free fatty acids are oxidised in the liver to ketones that are used by many tissues as an energy source instead of glucose. This occurs when intracellular levels of glucose are insufficient for energy metabolism as a result of severe insulin deficiency. In the liver, instead of being converted to triglycerides, free fatty acids are oxidised to acetoacetate, which is converted to hydroxybutyrate or acetone. Ketones are acids that cause central nervous system depression and act in the chemoreceptor trigger zone to cause nausea, vomiting and anorexia. They also accelerate osmotic water loss in the urine. Dehydration results from inadequate fluid intake in the face of accelerated water loss due to glucosuria and ketonuria. Dehydration and subsequent reduced tissue perfusion compounds the acidosis through lactic acid production. There is whole body loss of electrolytes including sodium, potassium, magnesium and phosphate and there is also intracellular redistribution of electrolytes following insulin therapy which may compound p Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Practice Essentials Diabetic ketoacidosis (DKA) is an acute, major, life-threatening complication of diabetes that mainly occurs in patients with type 1 diabetes, but it is not uncommon in some patients with type 2 diabetes. This condition is a complex disordered metabolic state characterized by hyperglycemia, ketoacidosis, and ketonuria. Signs and symptoms The most common early symptoms of DKA are the insidious increase in polydipsia and polyuria. The following are other signs and symptoms of DKA: Nausea and vomiting; may be associated with diffuse abdominal pain, decreased appetite, and anorexia History of failure to comply with insulin therapy or missed insulin injections due to vomiting or psychological reasons or history of mechanical failure of insulin infusion pump Altered consciousness (eg, mild disorientation, confusion); frank coma is uncommon but may occur when the condition is neglected or with severe dehydration/acidosis Signs and symptoms of DKA associated with possible intercurrent infection are as follows: See Clinical Presentation for more detail. Diagnosis On examination, general findings of DKA may include the following: Characteristic acetone (ketotic) breath odor In addition, evaluate patients for signs of possible intercurrent illnesses such as MI, UTI, pneumonia, and perinephric abscess. Search for signs of infection is mandatory in all cases. Testing Initial and repeat laboratory studies for patients with DKA include the following: Serum electrolyte levels (eg, potassium, sodium, chloride, magnesium, calcium, phosphorus) Note that high serum glucose levels may lead to dilutional hyponatremia; high triglyceride levels may lead to factitious low glucose levels; and high levels of ketone bodies may lead to factitious elevation of creatinine levels. Continue reading >>

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