What Is Diabetic Ketoacidosis (dka)?
Susan B. Sloane, BS, RPh, CDE, has been a registered pharmacist for more than 20 years and a Certified Diabetes Educator for more than 15 years. Her two sons were diagnosed with diabetes, and since then, she has been dedicated to promoting wellness and optimal outcomes as a patient advocate, information expert, educator, and corporate partner. Diabetic ketoacidosis, or DKA, is a term most people with diabetes hear at some point in their journey with the disease. Sometimes it happens when you are diagnosed, and other times it happens when you start to lose control of your blood sugars. If you heed some good practices and keep track of blood sugars, you can potentially avoid DKA, but sometimes even with the best efforts to keep it at bay, it happens. What causes DKA? DKA occurs when blood glucose starts to get very high and STAYS high for an extended period of time; this can happen over several hours or several days depending on many factors. The body’s response to prolonged periods of high blood sugars is to frantically try to get back to normal by secreting what are known as counter-regulatory hormones like glucagon, epinephrine, and cortical, just to name a few. These hormones cause more glucose in the blood and enhance the breakdown of fat for fuel because the cells can’t absorb the glucose due to lack of insulin. Insulin serves as the key to get energy into the cells. What happens next With the release of fat stores for energy and no ability to store fat, weight loss occurs rapidly. Fats are also broken down in the body to free fatty acids that create an acidic environment in the blood. This imbalance signals the kidneys to excrete the ketones that result from fat breakdown and the excess glucose. The kidneys work frantically to correct this, taking precious wate Continue reading >>
> Hyperglycemia And Diabetic Ketoacidosis
When blood glucose levels (also called blood sugar levels) are too high, it's called hyperglycemia. Glucose is a sugar that comes from foods, and is formed and stored inside the body. It's the main source of energy for the body's cells and is carried to each through the bloodstream. But even though we need glucose for energy, too much glucose in the blood can be unhealthy. Hyperglycemia is the hallmark of diabetes — it happens when the body either can't make insulin (type 1 diabetes) or can't respond to insulin properly (type 2 diabetes). The body needs insulin so glucose in the blood can enter the cells to be used for energy. In people who have developed diabetes, glucose builds up in the blood, resulting in hyperglycemia. If it's not treated, hyperglycemia can cause serious health problems. Too much sugar in the bloodstream for long periods of time can damage the vessels that supply blood to vital organs. And, too much sugar in the bloodstream can cause other types of damage to body tissues, which can increase the risk of heart disease and stroke, kidney disease, vision problems, and nerve problems in people with diabetes. These problems don't usually show up in kids or teens with diabetes who have had the disease for only a few years. However, they can happen in adulthood in some people, particularly if they haven't managed or controlled their diabetes properly. Blood sugar levels are considered high when they're above someone's target range. The diabetes health care team will let you know what your child's target blood sugar levels are, which will vary based on factors like your child's age. A major goal in controlling diabetes is to keep blood sugar levels as close to the desired range as possible. It's a three-way balancing act of: diabetes medicines (such as in Continue reading >>
15 Things You Need To Know About Infant Rapid Breathing
Rapid breathing in anyone can be caused by a variety of factors including trauma, stress, and exertion as well as illnesses. However, when it is a baby breathing rapidly many people begin to panic. Obviously babies cannot tell their parents why it is their breathing has increased or started to sound strained, so it can be alarming for parents and caregivers to witness. In some cases the panic may be justified which is why it's important that caregivers remain diligent in caring for the baby’s behavior and call their pediatrician or visit the local emergency room if necessary. More often than not rapid breathing in an infant is usually harmless and caused by something like the baby wiggling more than usual and simply getting themselves tired. Similar to how an adult may get winded after taking the stairs when they usually take the elevator. Rapid breathing in an infant can present itself very differently in each baby. It is important that whomever is giving care to the child understands the child’s typical breathing patterns. Often times a mother may notice another baby that appears to be breathing very rapidly but that child’s own mother however may know otherwise and that her baby just happens to breathe faster whilst napping. That is not to say that all rapid breathing in infants requires the child’s own caregiver to take notice. For example if any person sees a baby struggling to breathe, becoming pale, or any other alarming signs such as choking, it is a good idea to contact emergency services right away so the baby can receive appropriate medical treatment right away. So here are 15 things Moms need to know about rapid infant breathing. 15Baby May Have Obstructed Airway Rapid breathing in a baby can be the telltale sign of an illness, a trauma, or even simp Continue reading >>
What Causes Rapid Breathing In Infants & How Is It Treated?
Rapid or fast breathing is very common in infants and newborns. In most of the cases, there is no need to worry about unless it accompanies with any other symptom. In most of the cases, such infants with a fast heartbeat look healthy and can easily be breast fed. However, it is important to know what causes rapid breathing in infants and how to treat it. These causes need proper attention and care, because if they are left untreated they can be very detrimental to health of the child. Being a parent, one should be acquainted with all the causes of fast breathing and knowing when which needs immediate medical attention. Respiratory troubles are common in infants but some may be due to serious underlying causes that need immediate medical attention. Some of the conditions that cause rapid breathing in infants include Pneumonia - When rapid and intense fast breathing occurs in infants without any type of wheezing or croup sound, most probably it is a warning sign of pneumonia. It is one of the commonest causes of rapid breathing in infants, along with cough and fever. The child may breathe heavily and also show other signs of irritability, cough, fever and rapid heartbeat etc. Neonatal Respiratory Distress Syndrome - This disease is caused by immature or undeveloped lungs which lack the protective surfactant that helps the lungs inflate. In RDS or respiratory distress syndrome, infants may not be able to breathe properly. RDS or respiratory distress syndrome is common in newborns and infants although RDS running in families or maternal diabetes can possibly increase the risk of this disease. The symptoms of RDS or respiratory distress syndrome appear shortly after the birth of the child. Besides fast, rapid and shallow breathing, they also include the bluish skin tints, no Continue reading >>
Diabetes With Ketone Bodies In Cats
Diabetic ketoacidosis is an extreme medical emergency that requires immediate veterinary attention. The condition can result in an accumulation of fluid in the brain and lungs, renal failure or heart failure. Affected animals that are not treated are likely to die. With timely intervention and proper treatment, it is likely that an affected cat can recover with little to no side effects. Diabetes mellitus occurs when the pancreas fails to produce sufficient insulin, creating an inability to efficiently process the sugars, fats, and proteins needed for energy. The resulting build-up of sugar causes extreme thirst and frequent urination. Since sugar levels help to control appetite, affected animals may experience a spike in hunger and lose weight at the same time due to the inability to properly process nutrients. In extreme cases, diabetes may be accompanied by a condition known as ketoacidosis. This is a serious ailment that causes energy crisis and abnormal blood-acid levels in affected pets. Cats affected with diabetic ketoacidosis are likely to present with one or more of the following symptoms: Vomiting Weakness Lethargy Depression Excessive Thirst Refusal to drink water Refusal to eat Sudden weight loss Loss of muscle tone Increased urination Dehydration Rough coat Dandruff Rapid breathing Sweet-smelling breath Jaundice The exact cause of diabetes in cats is unknown, but it is often accompanied by obesity, chronic pancreatitis, hormonal disease, or the use of corticosteroids like Prednisone. Ketoacidosis, the buildup of ketone waste products in the blood that occurs when the body burns fat and protein for energy instead of using glucose, is caused by insulin-dependent diabetes. Diabetic ketoacidosis is commonly preceded by other conditions including: Stress Surgery Continue reading >>
What Are The Causes Of Rapid Breathing In An Infant?
Rapid breathing, often described as panting, is quite common in newborns. When no other symptoms are present--and rapid breathing comes and goes and the baby appears otherwise healthy and comfortable--there's usually no cause for concern. However, other causes of rapid breathing in an infant require careful monitoring and treatment. Parents should be educated about these signs and symptoms to determine whether to consult a pediatrician. Video of the Day Neonatal Respiratory Distress Syndrome Caused by immature lungs lacking in protective surfactant that helps the lungs inflate, Neonatal Respiratory Distress Syndrome or RDS makes breathing difficult, according to the National Institutes of Health and National Library of Medicine website MedlinePlus. RDS is most common in premature infants, although a family history of RDS, a rapid or cesarean delivery or maternal diabetes can increase the risk of developing it. Symptoms usually appear shortly after birth. Besides rapid and shallow breathing, they include bluish skin tint, nostril flaring, puffy limbs and even apnea where breathing briefly stops. When rapid, labored breathing occurs in infants without wheezing or croup sounds, it may be a sign of pneumonia. According to AskDrSears.com, the most important indicators of pneumonia include labored or rapid breathing together with cough and fever. Transient Tachypnea of the Newborn Often called “wet lungs,” transient tachypnea of the newborn or TTN appears hours after birth. TTN occurs when a newborn’s lungs remain filled with fetal fluid that usually clears when a baby passes through the birth canal and takes in his first breaths of air. Babies delivered by cesarean--who are born on the small side--and whose mothers have asthma or diabetes are at higher risk for TTN, ac Continue reading >>
Is Rapid Breathing During Sleep A Cause For Concern?
My husband breathes more rapidly in his sleep compared to me awake. I counted that it was 3.5 seconds between inhales. I don't think it was shallow breathing; his stomach was moving as he breathed. I recorded his breathing sound: If your husband takes a breath every 3.5 seconds, he is breathing at a rate of 17 breaths per minute. The breath rate range for healthy adults is 12 - 20 breaths per minute. If your husband has some extra weight on his abdomen, that may be reducing the degree to which he can expand his lungs when he is lying down. His body would automatically compensate for the change by increasing his breath rate. The rate of breathing also changes according to the stage of the sleep cycle. If his breathing is regular, there may not be any cause for concern. If his breathing is irregular, or if he periodically holds his breath, he may have a sleep-related breathing disorder. In the recording you provided, his breathing sounds regular and normal. Continue reading >>
Diabetes Update: Acute Complications
"Diabetes update: Acute complications" CE credit is no longer available for this article. Originally posted April 2001 MARJORIE CYPRESS, MS, C-ANP, CDE MARJORIE CYPRESS is a nurse practitioner and certified diabetes educator for Lovelace Health Systems, Albuquerque, N.M. Series Editor: Carolyn Robertson, RN, MSN, CDE KEY WORDS: acute complications, hyperglycemia, hypoglycemia, diabetic ketoacidosis, hyperosmolar hyperglycemic state, ketosis Critically high or low blood sugar in a patient with diabetes is a medical emergency. You'll need to be able to quickly identify and know how to manage the acute complications of diabetes to help a patient avoid a tragic outcome. Here's how. Jump to: Choose article section... Emergency treatment of acute complications of diabetes demands quick recognition of the problem and immediate intervention. High blood sugar can progress to diabetic ketoacidosis (DKA) in Type 1 diabetics, and hyperosmolar hyperglycemic state (HHS) in those with Type 2. But every diabetic patient taking a hypoglycemic agent is at risk for hypoglycemia, the most common—and most feared—complication. Here we'll review the pathophysiology behind DKA, HHS, and hypoglycemia; provide assessments that help distinguish one complication from another; and discuss emergency treatments and nursing strategies that can prevent a potentially fatal outcome. Too much sugar, too little insulin DKA, often referred to as diabetic coma, occurs when there's a profound lack of insulin in the body. Without insulin, the body can't use glucose for fuel. Cells starve as sugar accumulates. The blood becomes thick with sugar, which promotes osmotic diuresis. As the body loses water, the excess sugar spills into the urine, taking important electrolytes with it. Patients become thirsty and Continue reading >>
Shortness of breath is the distressing sensation that breathing requires more effort than usual. People who experience shortness of breath — also known as dyspnea — describe the sensation as an intense tightening in the chest, so-called “air hunger,” and, at its worst, a feeling of panic and suffocation. Ongoing breathing difficulties may be a sign of an underlying chronic condition, such as heart or lung disease or obesity. Breathing difficulties are fairly common and can be a part of everyday life for some active people. One-quarter of the population experiences dyspnea, and it is one of the most common reasons that people visit a hospital emergency room. Signs of severe breathing difficulty include a rapid respiratory and heart rate, gasping, wheezing, rib retractions, nasal flaring, and cyanosis, where the hands and feet turn bluish because of lack of oxygen. A person with severe breathing difficulty uses their neck and chest muscles to breathe. Shortness of breath can be associated with symptoms of chest pain, pain with inhalation (pleurisy), anxiousness, dizziness, fainting, cough, wheezing, bloody sputum, neck pain, and chest injury. What to Do if You Have Difficulty Breathing If you suddenly find it hard to breathe but you don’t have an underlying condition, stay calm and try to find the source of the problem. Situations that trigger acute breathing difficulty can provide an important clue to the underlying cause. Allergies (such as to mold, dander, or pollen) can cause shortness of breath, as can dust or pollutants in the environment, such as carbon-monoxide. Being at a high elevation can also cause shortness of breath. Altitudes above 4,000 feet can lower oxygen in your blood, which can lead to light-headedness and nausea as well. Rarely, medications Continue reading >>
Cat Breathing Problems – Causes, Symptoms And Treatment
: At a glance: About: Breathing disorders can come in a number of forms and for a number of reasons. Any type of breathing problem is a medical emergency requiring immediate veterinary attention. Causes: There are many causes including heart failure, fluid build-up in the abdomen or chest, a blockage in the pulmonary artery (embolism), infections, tumours, asthma, low oxygen levels in the blood. Types: Rapid breathing, open-mouthed breathing, noisy breathing and laboured breathing. Symptoms: This depends on the type of breathing problem but may include: Open-mouthed breathing Coughing Elbows sticking out Leghargy Blue mucous membranes Difficulty standing Diagnosis: Baseline tests as well as imaging to evaluate the internal structures, electrocardiogram and thoracentesis. Treatment: This depends on the underlying cause, but will include supportive care. Breathing is a part of the respiratory system which involves moving air into and out of the lungs. Oxygen is pulled into the lungs, which is then transported to all the cells within the body via the bloodstream, and carbon dioxide is expelled. There are a number of causes of difficulty breathing in cats, and different types of breathing abnormalities, which we have listed below. Polypnea/tachypnea – Rapid shallow breathing, sometimes open-mouthed (panting) Hypopnea – Shallow breathing Dyspnea – Shortness of breath Normal feline respiration: At rest, a cat breathes approximately 20-30 times per minute which is approximately twice that of a human. The process of breathing begins with inhalation Respiration should be smooth, quiet and without effort, this is known as eupnea. The suffix pnea meaning breath or breathing, you will note types of breathing difficulty end in pnea. Causes: Hyperpnea Rapid and heavy breathing 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 >>
Why Does Diabetic Ketoacidosis Cause Rapid Breathing?
Diabetes affects 18% of people over the age of 65, and approximately 625,000 new cases of diabetes are diagnosed annually in the general population. Conditions or situations known to exacerbate glucose/insulin imbalance include (1) previously undiagnosed or newly diagnosed type 1 diabetes; (2) food intake in excess of available insulin; (3) adolescence and puberty; (4) exercise in uncontrolled diabetes; and (5) stress associated with illness, infection, trauma, or emotional distress. Type 1 diabetes can be complicated by instability and diabetic ketoacidosis (DKA). DKA is a life-threatening emergency caused by a relative or absolute deficiency of insulin. CARE SETTING Although DKA may be encountered in any setting and mild DKA may be managed at the community level, severe metabolic imbalance requires inpatient acute care on a medical unit. Amputation Fluid and electrolyte imbalances Metabolic acidosis (primary base bicarbonate deficit) Psychosocial aspects of care Patient Assessment Database Data depend on the severity and duration of metabolic imbalance, length/stage of diabetic process, and effects on other organ function. ACTIVITY/REST May report: Sleep/rest disturbances Weakness, fatigue, difficulty walking/moving Muscle cramps, decreased Continue reading >>
What Causes Rapid Breathing In An Infant & How To Treat It?
Rapid breathing and breathlessness can occur at any age and in anyone. Often infants and newborn are known to pant or breathe rapidly. In majority of cases it is not a cause of concern unless rapid breathing is accompanied with other symptoms. Many time infants breathe rapidly but and they appear healthy. Even with such breathing they can easily breast feed. However, sometimes there are several other medical causes which may also cause tachypnea; a medical reference for breathing rapidly. Parents should be proactive and consult their pediatrician if they notice any change in breathing of their infant baby. What Are The Causes Of Rapid Breathing In Infants? Normally babies have faster breathing as compared to children and adults. Usually the respiratory rate of infants is between 40 to 60 breaths in a minute. It declines gradually as the child grows older. Among adults it is 12 to 20. If the child’s respiratory rate is more than 60 breaths in a minute and if it is constant then there is cause of concern. There are several medical reasons associated with persistent increased respiratory rate in infants. One of the most common medical causes of rapid breathing is infection in the respiratory tract of the child. Diseases such as pneumonia can cause rapid breathing. It is associated with other clinical symptoms such as high fever, cough, rattling sound in chest, rapid heart rate, poor breastfeeding, increased irritability etc. Transient tachypnea which is also known as wet lung is another cause in many newborn infants for rapid breathing. This condition develops soon after the birth of child, may be in few hours. It occurs when the lungs of baby are not able to remove fluid that was present at the time baby was in the womb. Usually the fluid clears out during the labor, bu Continue reading >>
Diabetes With Ketone Bodies In Cats
Diabetes Mellitus with Ketoacidosis in Cats The term “ketoacidosis” refers to a condition in which levels of acid abnormally increased in the blood due to presence of “ketone bodies.” Meanwhile, diabetes is a medical condition in which the body cannot absorb sufficient glucose, thus causing a rise the blood sugar levels. In diabetes with ketoacidosis, ketoacidosis immediately follows diabetes. It should be considered a dire emergency, one in which immediate treatment is required to save the life of the animal. Typically, the type of condition affects older cats; in addition, female cats are more prone diabetes with ketoacidosis than males. Symptoms and Types Weakness Lethargy Depression Lack of appetite (anorexia) Muscle wasting Rough hair coat Dehydration Dandruff Sweet breath odor Causes Although the ketoacidosis is ultimately brought on by the cat's insulin dependency due to diabetes mellitus, underlying factors include stress, surgery, and infections of the skin, respiratory, and urinary tract systems. Concurrent diseases such as heart failure, kidney failure, asthma, cancer may also lead to this type of condition. Diagnosis You will need to give a thorough history of your cat’s health, including the onset and nature of the symptoms, to your veterinarian. He or she will then perform a complete physical examination, as well as a biochemistry profile and complete blood count (CBC). The most consistent finding in patients with diabetes is higher than normal levels of glucose in the blood. If infection is present, white blood cell count will also high. Other findings may include: high liver enzymes, high blood cholesterol levels, accumulation in the blood of nitrogenous waste products (urea) that are usually excreted in the urine (azotemia), low sodium levels Continue reading >>
Breathing Difficulties In Dogs
Dyspnea, Tachypnea, and Panting in Dogs The respiratory system has many parts, including the nose, mouth, throat (pharynx and larynx), windpipe (trachea), and lungs. Air is pulled in through the nose or mouth and is then carried down into the lungs, through a process referred to as inspiration. In the lungs, oxygen is transferred to the red blood cells. The red blood cells then carry oxygen to other organs in the body. While oxygen is being transferred to the red blood cells, carbon dioxide is transferred from the red blood cells to the air within the lungs. It is then pushed out through the nose or mouth through a process referred to as expiration. Diseases in any part of the respiratory system and even in other parts of the body can lead to breathing difficulties in dogs. The problem can affect all breeds and ages and can quickly become life threatening. If your dog is having problems with breathing, he should be seen by a veterinarian as soon as possible. Respiration and Respiratory Rate for Dogs Differentiating between a dog who is breathing normally and one who is having difficulty breathing is not always as simple as it might seem. At rest, healthy dogs should have a respiratory rate of between 20 and 34 breaths per minute and they should not appear to be putting much effort into breathing. Of course, dogs may breathe more rapidly and/or more deeply in response to normal factors such as warm temperatures, exercise, stress, and excitement. Owners should get a feel for what is normal for their dogs before any health problems develop. How does your dog breathe when he is at rest? While going for a walk? After vigorous play? With this knowledge in hand, you will be able to pick up subtle changes in your dog’s respiratory rate and effort before a crisis develops. Sym Continue reading >>