NAME MATRIC CARD NO.

MOHAMAD ZARIF MUAZ BIN ROSLAN

D2010137494

RIDWAN BIN SHAMSUDIN D20101037472

DIABETIC KETOACIDOSIS

A doctor has ordered a series of lab tests including:1. Blood sugar level. 2. Ketone level. 3. Blood acidity.4. Additional tests

1. Blood electrolyte tests2. Urinalysis3. Chest X-ray4. A recording of the electrical activity of

the heart (electrocardiogram)

…..in order to confirmed Diabetic ketoacidosis

What would the tests revealed? What is Diabetic ketoacidosis?

Case : GluCat-03

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DKA??

US??GLUCOSE??

INSULIN??

DIABETIC KETOACIDOSIS

(DKA)

Diabetic Ketoacidosis

Diabetic ketoacidosis is a problem that occurs in people with diabetes.

Diabetic ketoacidosis is a dangerous complication of diabetes mellitus in which the chemical balance of the body becomes far too acidic.

Diabetic ketoacidosis (DKA) always results from a severe insulin deficiency. 

Cont..

It occurs when the body cannot use sugar (glucose) as a fuel source because there is no insulin or not enough insulin.

Fat is used for fuel instead.

DKA Without insulin from the pancreas, glucose from food is unable to be processed by the body.

The liver produces more glucose to feed the body , but

without insulin, the glucose accumulates in the

bloodstream.

Without glucose for energy, the body breakdown fat. Ketones are the by

product of fat metabolism and build up in the bloodstream. This can be fatal that

causing heart rhythm abnormalities.

Water is lost along with excess glucose and ketones. The lose of water leads to dehydration, which worsens the ketoacidosis in a

vicious cycle and causes low blood pressure and shocks.

The kidney utilize water to empty the bloodstream of

excess glucose and ketones. Ketones and glucose are transferred into

urine

BLOOD TESTS

Blood sugar level

Ketones level

Blood acidity

Blood sugar level will rise (hyperglycemia).

As your body breaks down fat and protein for energy, your blood sugar level will continue to rise.

When our body breaks down fat and

protein for energy, toxic

acids known as ketones will

enter our bloodstream.

When we have excess ketones in

our blood, our blood will become acidic (acidosis).

This can damage organs

throughout your body.

Blood sugar level

Blood sugar is the amount of glucose present in the blood.

Normal results for a fasting blood sugar test are 70 to 100 mg/dl.

When the levels are higher than 140 mg/dl with a non-fasting test, the condition may be called hyperglycemia.

If levels are below 70 mg/dl, the condition may be referred to as hypoglycemia, meaning low blood sugar.

Ketones level

Ketone blood testing is the preferred method for assessing the presence of ketones during times of sickness.

If the Ketone level is below than 0.6 mmol/L is normal.

The person with a reading above 1.5 mmol/L indicate a greater risk for developing Ketoacidosis (DKA).

Blood acidity The acidity or alkalinity of blood. A variety of factors affect blood pH

including what is ingested, vomiting, diarrhea, lung function, endocrine function, kidney function, and urinary tract infection.

The normal blood pH is tightly regulated between 7.35 and 7.45.

The pH less than 7.3 will lead to Ketoacidosis (DKA). 

Electrocardiogram

DKA may be precipitated by a cardiac event, and the physiological disturbances of DKA may cause cardiac complications.

An ECG may reveal signs of acute myocardial infarction that could be painless in patients with diabetes, particularly in those with autonomic neuropathy.

Additional tests

Urinalysis

Positive for glucose and

ketones. Other potential findings include leukocytes and nitrites in the presence of infection.

This is a picture of your lungs and

heart. Caregivers may use the x-ray to look for signs of

infection, such as pneumonia.

Chest X-ray

GENERALLY..

INSULIN PROBLEMS

FIND ANOTHER SOURCE

FATTY ACIDS USED

KETONES PRODUCED GET DKA

• Insulin– Not enough of them– Insulin from body cannot be synthesized

• Another sources– Body will used amino acids, fats and lipid as sources

• Fatty acid used– Ketone will produce from oxidation process– Increase blood acidity in our body– known as ketonemia

WHY MUST KETOACIDOSIS??

What is ketones??

• Three water-soluble compounds that are produced as by-products when fatty acids are broken down for energy in the liver.

• acetone, acetoacetic acid, and beta-hydroxybutyric acid.

• Smell of acetone in breath is a common feature in ketosis.

• Ketosis is a state of elevated levels of ketone bodies in the body.

WHY MUST DIABETIC??

The body shifts from its normal fed metabolism by using fat for

fuel

The resulting increase in blood

sugar occurs, because insulin is

unavailable to transport sugar

into cells for future use.

This will lead the person to get diabetes.

SYMPTOMS

TREATMENTThe goal of treatment :

to correct the high blood sugar level with insulin.

to replace fluids lost through urinati on and vomiting.

Fluid replaceme

nt

•receive fluids either

orally or through a

vein (intravenous

ly) until you're

rehydrated. The fluids

will replace those you've lost through

excessive urination, as well as help dilute the

excess sugar in your blood.

Electrolyt

e replaceme

nt

•Electrolytes are minerals

in your blood that

carry an electric

charge, such as sodium, potassium

and chloride.

The absence of insulin can lower

the level of several

electrolytes in your

blood. You'll receive

electrolytes through

your veins to help keep your heart,

muscles and nerve cells functioning normally.

Insulin

therapy

•Insulin reverses the

processes that cause

diabetic ketoacidosis. Along with fluids and

electrolytes, you'll

receive insulin

therapy usually

through a vein. When your blood sugar level falls below 240 mg/dL and your

blood is no longer

acidic, you may be able

to stop intravenous

insulin therapy and resume your

normal insulin

therapy.