Download diabetic ketoacidosis

DIABETIC KETOACIDOSIS
Diabetes Mellitus {sugar diabetes}
• An ancient disease
• Names in ancient times by Greek
physicians
• The noted that those with diabetes
produced large amounts of urine that
attracted bees and other insects
Diabetes {to siphon or pass through}
Mellitus {honey sweet}
Diabetes Mellitus
• Inadequate insulin activity of the body
• Due to inadequate production of insulin or
to decreased responsiveness of body cells
to insulin
• Insulin is crucial to maintain normal blood
glucose levels
• Insulin allows the body to store glycogen,
protein and fat as sources of energy
• Glucose is especially important for brain
cells as this is the only substance the brain
cells can utilize for energy
• Insulin of course is a hormone
• Hormone
Chemical messenger
Role of the kidneys
• Blood is filtered through the gloumeruli
• Glucose and water pass into the proximal
tubule
• Water and glucose is reabsorbed
• The amount of glucose reabsorbed is
dependent on glucose levels
• Glucose lost in urine can result in
dehydration affecting osmosis
Osmosis
• Water crosses the cell membrane to
achieve equivalence on both sides
• Relative to the kidneys; tubules and
surrounding capillaries
When glucose spills into the urine:
• Concentration inside the tubule is higher
than that of the capillaries
• Water follows glucose in urine causing a
noted water loss
This is called osmotic diuresis
• Diuresis is the formation and secretion of
urine
Glycosuria
• Presence of glucose in urine
• Creates the sweet urine {Mellitus; honey
sweet}
• With osomotic diuresis, there is also a loss
of K+
DIABETIC KETOACIDOSIS
• Complications of Type I diabetes
• Due to decreased insulin intake
• Marked by:
high blood glucose
metabolic acidosis
coma
• Serious and potentially life-threatening
• Insulin deficiency plus increased glucagon
activity
• Glucagon; hormone released by the
pancreas to raise blood glucose levels
Pathophysiology
Ketosis
• The body uses fat as opposed to glucose
as its primary energy source
• Fatty acids in the blood significantly rise
• Most of the fatty acid is utilized
• Some is taken in by liver cells and
catoblized
Catabolism:
Breaking down phase of metabolism
• The catabolism of fatty acids in the liver
produces aceoacetic acid
• When more is released that the body can
use it accumulates in the blood along
with…
• Acetone and B-hydorxybutyric acid
• Acetone is naturally produced and
disposed of in the human body as a result
of normal metabolic processes.
• beta-hydroxybutyrate is synthesized in the
liver from acetyl-coA and can be used as
an energy source by the brain when blood
glucose is low
Acetoacedic acid
Acetone
B-hydroxybutyric acid
collectively called
ketone bodies
Significant quantities in the blood is called…
KETOSIS; hence……..
DIABETIC KETOACIDOSIS
or
DIBETIC COMA
• In the initial phase acute hyperglycemia
• Body cells cannot take in glucose
• Gluconeogenesis contributes more blood
glucose
• Loss of glucose in urine + osmotic diuresis
causes severe dehydration
• As the body Δs to fat-based metabolism,
level of ketones rise
Gluconeogenesis
The compensatory mechanism within the
cells to combat low glucose levels
• The ketone load accounts for the acidosis
• When the pH decreases to about 6.9 the
patient is hours from death
SIGNS AND SYMPTOMS
• Onset is slow
12 to 24 hours
• Increased urinary output
• Dry, warm skin
• Hunger and thirst
• General malaise
• Tachycardia |
volume
• Weakness |
depletion
• Kussmaul’s Respirations
Rapid, deep breathing in an attempt to expel
CO2
• Fruity odor on the breath
Some acetone is expelled through the lungs
Cardiovascular System
Pulse
Blood pressure
Rapid
Low
Respiratory System
Rate
Breath Odor
Exaggerated air hunger
Acetone
Nervous System
Mental Status
Restless to Unconscious
Gastrointestinal System
Mouth
Thirst
Vomiting
Abdominal Pain
Dry
Intense
Common
Frequent
Ocular System
Vision
Dim
Assessment of a patient with AMS or is
Unconscious