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Diabetic ketoacidosis

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Text of Diabetic ketoacidosis

  • 1.

2. Definition L ab T reatment C omplications P athophysiology S igns andS ymptoms E tiology D iagnosis contents 3.

  • Diabetic ketoacidosisisnear complete deficency of insulin and elevated levels of stress hormones
  • glucagon
  • cathecolamine
  • cortisol
  • growth hormone
  • acute metabolic complication ofdiabetic characterized by
  • Hyperglycemia
  • hyperketonemia
  • metabolic acidosis

Defination 4. DKAis alife - threatening comp DKAis alife - threatening complicationin Pt. with untreated DM(chronic high blood sugar or hyperglycemia).DKAoccurs mostly intype 1 DM DKAis less commonin type 2 DM, but it may occur in situations of physiologic stress .Pts .with new undiagnosed Type 1 DM frequently present to hospitals with DKA Definition 5.

Etiology

  • Insulin deficiency c relative or absolute increase
    • in glucagon(Inadequate insulin administration)
    • Infection or Inflammation ( pneumonia, UTI,
    • gastroenteritis, sepsis)
    • Ischemia or Infarction ( cerebral, coronary, mesenteric,
    • peripheral)
    • Intra - abdominal process (pancreatitis, cholecystitis)

6. 1 .Hyperglycemia :gluconeogenesis, glycogenolysis ,glucose uptake into cell (underutilization) 2.Ketosis: lipolysis, ketogenesis , Peripheral tissue uptake ketone -- )ketonemia 3 .Hypertriglyceridemia :free fatty acid 4.Osmotic diuresis :hyperglycemia--) renal loss glucose, Na & K--)electrolyte imbalance 5 .Volume depletion : hyperglycemia, glucosuria & osmotic diuresis -- )dehydration Pathophysiology 7.

  • S igns andS ymptoms Initial symptoms ofDKA
    • Anorexia, nausea, vomiting, abdominal pain
    • Polyuria, polydipsia
    • Dehydration -- ) dry mucous membranes, tachycardia, hypotension
    • Alterated mental function --) somnolence, stupor,coma
    • Fever is not a sign ofDKA-- )signifies underlying infection
  • Classic signs ofDKA
    • Kussmaul s respirations(deep) to compensate for metabolic acidosis
    • with acetone odor on Pt. breath

Signs and Symptoms 8. 1 .Glucose & ketone in serum & urine2 .Serum electrolyte, BUN, Cr, Ca, PO4 3 .Blood gas:capillary or arterial blood gas 4 .EKG:hypo /hyperkalemia 5 .CBC UA Lab 9. Serum glucose ) 300 mg / dl Acidosis : serum HCO3 7.3 Moderate: HCO3 10-15 mq / L & pH 7.1-7.3Severe: HCO3 < 10mq / L& pH