Diabetic Keto Acidosis

Diabetic Keto Acidosis

What Causes Diabetic Ketoacidosis

Diabetic keto acidosis occurs when diabetic get an extreme metabolic state caused by insulin decreased effective circulating insulin, insulin resistance, and increased production of counter regulatory hormones. It is the most cause of morbidity and is the most common cause of diabetes related deaths in children and adolescents with Type 1 diabetes (3-5%). Mortality is predominantly due to cerebral oedema which occurs in 0.3% to 1% of all DKA in children. DKA consists of the biochemical triad of ketonaemia (ketosis), hyperglycaemia, and acidaemia. The breakdown of fatty acids (lipolysis) produces ketone bodies (ketogenesis), which are acidic. Free fatty acids released by the increased rate of lipolysis are metabolized in the liver into β-hydroxybutyrate, acetoacetate and acetone (collectively known as “ketones”). The resulting ketonaemia raises plasma hydrogen ion concentration (i.e. lowers pH) thus leading to the development of ketoacidosis. Ketonaemia alone doesn’t always result in metabolic acidosis. It indicates that insufficient insulin is present and that other metabolic changes (e.g.hyperglycemia) associated with insufficient insulin will result in increased fluid losses. Under conditions of normal thirst sensation, diabetic will be able to keep up with the increased fluid by drinking. But when interrupted by nausea and vomiting, there can be a rapid progression to dehydration and metabolic keto acidosis.
Diagnosis of DKA is based on clinical suspicion followed by biochemical confirmation:
Joint British Diabetes Societies :
• Hyperglycaemia (blood glucose >11 mmol/L or 198 mg/dL)
• Metabolic acidosis (venous pH <7.3 or Bicarbonate(HCO3) <15 mmol/L or both) • Ketonuria / ketonaemia (>3 mmol/L or result of urine dipstick testing more than 2+)
American Diabetes Association :
• Hyperglycaemia (blood glucose >13.9 mmol/L or 250.2 mg/dL)
• Metabolic acidosis (venous pH <7.3, Bicarbonate (HCO3) <18 mmol/L) • Positive result for urine or serum ketones by nitroprusside reaction Individuals may present with Diabetic Keto Acidosis at any age and with or without a previous diagnosis of diabetes. Risk factors for Diabetic Keto Acidosis in children with newly diagnosed Type 1 diabetes include : • Children under 4 years old • 1st degree relative with Type 1 diabetes • Lower socioeconomic status • High dose of glucocorticoids, antipsychotics, diazoxide and immunosuppresives Risk factors for Diabetic Keto Acidosis in children with established Type 1 diabetes include : • Poor metabolic control • Previous history of Diabetic Keto Acidosis • Female adolescents • Eating disorders • Lower socioeconomic status Signs and Symptoms of Diabetic Ketoacidosis DKA usually develops quickly, within 24 hours. Typically, patients develop polyuria and polydipsia along with vomiting, dehydration, and, if severe, a depressed or deteriorating mental status, including coma. DKA symptoms include : • Polyuria • Polydipsia • Weight loss • Nausea and vomiting • Dehydration / Vascular volume. Determine patient’s clinical hydration status by examining vital signs (heart rate, blood pressure, pulse pressure), the quality of peripheral pulse quality and capillary refill time. Fluid management may be the most important early treatment intervention. • Weakness, drowsiness, somnolence and lethargy • Semi coma and coma may also occur (throughout the first 48 hours the patient should be closely monitored for neurologic deterioration due to cerebral oedema) • Depressed or deteriorating mental status • Kussmaul respiration (a characteristic deep hyperventilation). Kussmaul respiration occur when the pH is ≤ 7.25 • Acetone on breath (smell of pear drops or fruity smelling) • Cardiovascular instability after 1st hour of fluid therapy

Leave a Reply

Your email address will not be published.

This site uses Akismet to reduce spam. Learn how your comment data is processed.