DIABETIC KETOACIDOSIS

DIABETIC KETOACIDOSIS - ACUTE COMPLICATIONS OF DIABETES MELLITUS



The three acute complications of Diabetes mellitus are as follows :-
A. DIABETIC KETOACIDOSIS
B. NON-KETOTIC HYPEROSMOLAR COMA (NKHOC)
C. LACTIC ACIDOSIS




In this article, we will discuss about Diabetic Ketoacidosis :-

DIABETIC KETOACIDOSIS

DEFINITION

Diabetic ketoacidosis is a life threatening medical emergency where decreased levels of insulin result in burning of fatty acids and production of ketone bodies which cause several manifestations like vomiting, abdominal pain, shortness of breath and occasionally coma.

CLINICAL FEATURES

The patient presents with symptoms while examination reveals signs :-

 

SYMPTOMS

These include the following symptoms for diabetic ketoacidosis :-

 

SIGNS

The signs of Diabetic ketoacidosis or DKA include the following :-

  1. Tachycardia
  2. Dry mucous membrane
  3. Dehydration
  4. Hypotension
  5. Kussmaul respiration
  6. Tachypnea
  7. Abdominal tenderness
  8. Fever
  9. Fruity odour of breath 
  10. Acute Abdomen


 

PATHOGENESIS

The pathogenesis of diabetic ketoacidosis revolves around decreased insulin action and metabolic disorders as explained below :-

diabetic-ketoacidosis-dm-complications


INVESTIGATIONS

The tests for diabetic ketoacidosis reveal following :-

1. Hyperglycemia - Blood sugar is 400-600 mg%
2. TLC - Leucocytosis
3. K+ - increases due to shifting of Potassium from intracellular to extracellular compartment due to decreased insulin)
4. Blood urea - increase due to intravascular fluid depletion
5. Serum osmolality - 300-320 mosm/kg



6. Plasma ketones - positive
7. Metabolic acidosis - Low HCO3- with increased anion gap
8. Hypertriglyceridemia-Hyperlipoproteinemia
9. Hyperamylasemia
10. PSEUDOHYPONATREMIA - There is reduction of 1.6 meq of serum sodium for each 100mg/dL rise in serum glucose. Therefore, when we treat a case of DKA, as the blood glucose level falls, then measured serum sodium rises.

    COMPLICATIONS

    Complications of Diabetic ketoacidosis are as follows :-
    1. Cerebral oedema (most dangerous complication, seen mostly in children)
    2. Venous thrombosis
    3. ARDS
    4. MI
    5. Acute gastric dilatation

    TREATMENT

    Management of diabetic ketoacidosis comprises of :-

    1. Fluids - 0.9% saline
    2. Insulin - Regular Insulin is given I.V in DKA
    3. Treat precipitating events - Non-compliance, infection by antibiotics
    4. K+ Replacement - initially, when patient comes, he is hyperkalemic, later on, when patient is treated with insulin, serum Potassium levels goes down, and may require potassium replacement
    5. Injection HCO3 I.V if Ph<7

    Reference- Harrison 18th edition

    Keep reading to Non-Ketotic Hyperosmolar Coma or jump to Lactic Acidosis.

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