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 acidAcetoneB-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