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Why Is There Acidosis In Dka?

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What is DIABETIC KETOACIDOSIS? What does DIABETIC KETOACIDOSIS mean? DIABETIC KETOACIDOSIS meaning - DIABETIC KETOACIDOSIS definition - DIABETIC KETOACIDOSIS explanation. Source: Wikipedia.org article, adapted under https://creativecommons.org/licenses/... license. SUBSCRIBE to our Google Earth flights channel - https://www.youtube.com/channel/UC6Uu... Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes mellitus. Signs and symptoms may include vomiting, abdominal pain, deep gasping breathing, increased urination, weakness, confusion, and occasionally loss of consciousness. A person's breath may develop a specific smell. Onset of symptoms is usually rapid. In some cases people may not realize they previously had diabetes. DKA happens most often in those with type 1 diabetes, but can also occur in those with other types of diabetes under certain circumstances. Triggers may include infection, not taking insulin correctly, stroke, and certain medications such as steroids. DKA results from a shortage of insulin; in response the body switches to burning fatty acids which produces acidic ketone bodies. DKA is typically diagnosed when testing finds high b

Lactic Acidosis In Diabetic Ketoacidosis

Go to: Discussion Lactate acidosis is a common finding in DKA. Several pathophysiological mechanisms are responsible for the extremely high lactate values sometimes found in patients with ketoacidotic. Originally, elevated lactate values in patients with DKA were thought to be the result of inadequate tissue perfusion and oxygenation (due to a contracted intravascular volume, aggravated by the presence of macrovascular disease and microangiopathies, an increased amount of glycosylated Hb, and an abnormal platelet function).1–3 The resulting relative hypoxaemia stimulates the process of anaerobic glycolysis, where pyruvic acid is converted to l-lactate, yielding two ATP molecules. More recently, however, it was demonstrated that the metabolic derangements itself present in DKA might contribute as well to the elevated lactate levels.4 Various studies have reported the presence of a positive correlation between glucose levels and ketone (β-hydroxybutyrate) levels on the one hand, and lactate levels on the other hand.4 5 This could be explained by various intracellular and extracellular mechanisms. First, an increased amount of d-lactate is formed in erythrocytes. Since erythrocytes Continue reading >>

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  1. One of our CDI noted an elevated lactic acid and queried the physician for a diagnosis. The patient did not have Sepsis. Our physician advisor said not to do that because the next lactic acid was normal. She said we should also be looking for the underlying cause of the lactic acidosis and not querying for the diagnosis. A diagnosis of lactic acidosis will give us a CC. Other CDI's have said that if the elevated lactic acid was treated, monitored or evaluated we should be querying for the diagnosis. Does anyone have any direction on how this should be handled?
    Is lactic acidosis always inherent in other conditions and that's what we should focus on?
    What can we pick up the diagnosis by itself as a CC / when should we query to get to documented in the chart?
    Are there any other clinical parameters we should be looking at when evaluating whether we should query such as the anion gap?
    Is there a specific treatment for metabolic acidosis?
    Thank you,
    Christine Butka RN MSN
    CDI Lead
    CentraState Medical Center
    Freehold, NJ

  2. What a timely comment. Recently, our coding auditor suggested that we should always keep an eye out for the cc "acidosis". It seems to me that lactic acidosis could be inherent to the disease process of sepsis and therefore should not be captured. Any thoughts?
    Yvonne B RN CDI Salinas, CA.

  3. Hello all! I agree, I believe lactic acidosis is inherent to sepsis. It is one of the most important indicators that gives the clnician a clue that sepsis may be present. Our fluid administration policy was actually developed on the lactic acid result: the higher the number, the more fluid we bolused (in non-CHF patients, of course). In cases were Sepsis is determined not to be present, we will query the provider, providing they treated or monitored the acidosis in some manner
    Shiloh

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Anion gap usmle - anion gap metabolic acidosis normal anion gap metabolic acidosis

Acidosis

Acidosis is a condition in which there is too much acid in the body fluids. It is the opposite of alkalosis (a condition in which there is too much base in the body fluids). The kidneys and lungs maintain the balance (proper pH level) of chemicals called acids and bases in the body. Acidosis occurs when acid builds up or when bicarbonate (a base) is lost. Acidosis is classified as either respiratory or metabolic acidosis. Respiratory acidosis develops when there is too much carbon dioxide (an acid) in the body. This type of acidosis is usually caused when the body is unable to remove enough carbon dioxide through breathing. Other names for respiratory acidosis are hypercapnic acidosis and carbon dioxide acidosis. Causes of respiratory acidosis include: Metabolic acidosis develops when too much acid is produced in the body. It can also occur when the kidneys cannot remove enough acid from the body. There are several types of metabolic acidosis: Diabetic acidosis (also called diabetic ketoacidosis and DKA) develops when substances called ketone bodies (which are acidic) build up during uncontrolled diabetes. Hyperchloremic acidosis is caused by the loss of too much sodium bicarbonate Continue reading >>

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  1. metalmd06

    Does acute DKA cause hyperkalemia, or is the potassium normal or low due to osmotic diuresis? I get the acute affect of metabolic acidosis on potassium (K+ shifts from intracellular to extracellular compartments). According to MedEssentials, the initial response (<24 hours) is increased serum potassium. The chronic effect occuring within 24 hours is a compensatory increase in Aldosterone that normalizes or ultimatley decreases the serum K+. Then it says on another page that because of osmotic diuresis, there is K+ wasting with DKA. On top of that, I had a question about a diabetic patient in DKA with signs of hyperkalemia. Needless to say, I'm a bit confused. Any help is appreciated.

  2. FutureDoc4

    I remember this being a tricky point:
    1) DKA leads to a decreased TOTAL body K+ (due to diuresis) (increase urine flow, increase K+ loss)
    2) Like you said, during DKA, acidosis causes an exchange of H+/K+ leading to hyperkalemia.
    So, TOTAL body K+ is low, but the patient presents with hyperkalemia. Why is this important? Give, insulin, pushes the K+ back into the cells and can quickly precipitate hypokalemia and (which we all know is bad). Hope that is helpful.

  3. Cooolguy

    DKA-->Anion gap M. Acidosis-->K+ shift to extracellular component--> hyperkalemia-->symptoms and signs
    DKA--> increased osmoles-->Osmotic diuresis-->loss of K+ in urine-->decreased total body K+ (because more has been seeped from the cells)
    --dont confuse total body K+ with EC K+
    Note: osmotic diuresis also causes polyuria, ketonuria, glycosuria, and loss of Na+ in urine--> Hyponatremia
    DKA tx: Insulin (helps put K+ back into cells), and K+ (to replenish the low total potassium
    Hope it helps

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Hypothermia: A Complication Of Diabetic Ketoacidosis

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  1. Dm 2 with ketoacidosis

    I had a case to code a couple of days ago; patient had "diabetic ketoacidosis." There was no description as to the type of diabetes, so I went with type 2. At this point, I noticed there are combination codes for DM 1, DM due to drug or chemical, due to underlying condition and specified type NEC, but there is no combination code for DM 2 with ketoacidosis. I coded it as DM 2 with complication NEC E11.69 and Ketoacidosis E87.2. The doctor gave an additional diagnosis of lactic acidosis, which is also coded as E87.2. Does anyone have any insights on a better way to code this, or the rationale of not having a combination code for DM type 2 with ketoacidosis? (Incidentally, the patient also had urogenital warts, severe sepsis present on admission, and there was no mention of any kind kidney malfunction.)

  2. I found an answer on another thread that indicated to go with "DM specified type NEC with ketoacidosis (without coma) E13.10" instead of DM 2 with complication NEC E11.69 and ketoacidosis E87.2 (even though the type of diabetes is not specified); seems strange, but I guess that's what I'll do if it ever comes up again.

  3. rbandaru

    Hello,
    As per coding Clinic Diabetic with ketoacidosis code is E13.10 below is reference from coding Clinic.
    Assign code E13.10, Other specified diabetes mellitus with ketoacidosis without coma, for a patient with type 2 diabetes with ketoacidosis. Given the less than perfect limited choices, it was felt that it would be clinically important to identify the fact that the patient has ketoacidosis. The National Center for Health Statistics (NCHS), who has oversight for volumes I and II of ICD-10-CM, has agreed to consider a future ICD-10-CM Coordination and Maintenance Committee meeting proposal
    Regards
    Dr.Ramnath Bandaru, CCS, CPC
    American Medical Services LLC
    http://amshealth.com/
    Twitter: @HospitalCoders

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