It can happen when your blood sugar is too high for too long. Diabetic ketoacidosis dka is a potentially lifethreatening complication of diabetes mellitus. Target audience this educational activity has been designed to meet the educational needs of. We discuss the pathophysiology of diabetic ketoacidosis, its management, and its complications.
Prior to the introduction of insulin to clinical medicine by banting and best in 1922, dka had a mortality rate greater than 60% 2. When your cells dont get the glucose they need for energy, your body begins to burn fat for energy, which produces ketones. Diabetic ketoacidosis dka is a frequent abnormal metabolic entity seen in highdependency units such as critical care units and in the emergency department. Epidemiology and pathophysiology of diabetic ketoacidosis guidance on diagnosis, management and complications the nurses role in caring for patients with dka diabetic ketoacidosis is a potentially lifethreatening complication of diabetes, making it a medical emergency. Consequently, a person feels hungry despite of eating adequately and the level of glucose in the body is increasing because cell. Pathophysiology of diabetic ketoacidosis 2018 nursing. No potential conflicts of interest relevant to this article were reported. Nurses need to know how to identify and manage it management of diabetic. Evidence implicating excess stress hormone secretion as a necessary event in the development of severe metabolic. Box 1 signs and symptoms of diabetic ketoacidosis7. Diabetic ketoacidosis dka is a buildup of acids in your blood. Although ketoacidosis is a form of metabolic acidosis because of the addition of acids, it is discussed separately in this chapter to emphasize the metabolic and biochemical issues required to understand the clinical aspects of this disorder see margin note. Dka is the first manifestation of type 1 dm in a minority of patients. Although they have important differences, they both occur because of lack of insulin effect and can be considered two manifestations of the same underlying mechanism.
Diabetic ketoacidosis is characterized by a biochemical triad of hyperglycemia, ketonemia, and acidemia, with rapid symptom onset. Pathophysiology diabetic ketoacidosis dka is a complex disordered metabolic state characterised by hyperglycaemia, acidosis, and ketonaemia. More commonly seen in patients with type 1 diabetes t1d, dka results when lipid breakdown generates a surplus of acidic. Management of diabetic ketoacidosis in adults age 16. In the usual clinical situation, a rise in counterregulatory hormones contributes to accelerated gluconeogen esis, glycogenolysis, and impaired glucose utilization by peripheral tissues and leads to diabetic ketoacidosis. The data both supporting and negating a primary role for insulin deficiency in the pathogenesis of diabetic ketoacidosis are examined. Diabetic ketoacidosis dka is a medical emergency and represents a lifethreatening decompensation of metabolism that requires prompt recognition and appropriate treatment, with careful monitoring of clinical and biochemical indices. Pathophysiology of ketoacidosis in type 2 diabetes. The most common cause of ketoacidosis is diabetic ketoacidosis but can also be caused by alcohol.
Timely diagnosis, comprehensive clinical and biochemical evaluation, and effective management is key to the successful resolution of dka and hhs. Dka must be differentiated from acidosis and coma from other causes. Diabetic ketoacidosis and hyperglycemic hyperosmolar state risk factors for dka in patients with known diabetes include insulin omission, poor metabolic control, previous episodes of dka, gastroenteritis with persistent vomiting and inability to maintain hydration. Diabetic ketoacidosis in children descriptionetiology diabetic ketoacidosis dka is a lifethreatening medical emergency brought on by severe insulin deficiency, which usually results in hyperglycemia i. Diabetic ketoacidosis is characterized by a serum glucose level greater than 250 mg per dl, a ph less than 7. We discuss the metabolic setting that is required to allow for the formation of ketoacids in the liver at a high rate and what sets the. What is the pathophysiology of diabetic ketoacidosis. The condition may develop in individuals who have gestational, insulin dependent type 1, or noninsulin dependent type 2 diabetes. Pathophysiology of diabetic ketoacidosis ffa to liver ketogenesis proteolysislipolysis acidosis v alkali reserve absolute insulin deficiency stress, infection or insufficient insulin counterregulatory hormones glucagon cortisol catecholamines growth hormone v. Management of diabetic ketoacidosis and hyperosmolar. Whatyoushouldknow diabeticketoacidosis dkaisacommon,serious,andpreventablecomplicationoftype1diabetes,withamortalityof3. Diabetic ketoacidosis and hyperosmolar hyperglycemic. Diabetic ketoacidosis dka, also known as diabetic acidosis or diabetic coma, is a severe complication of diabetes mellitus dm.
Pathophysiology of diabetic ketoacidosis nursing journal. Table of content introduction definition diagnosis epidemiology pathophysiology etiology clinical presentation laboratory evaluation management complications topics of discussion references. Diabetic ketoacidosis in adults to the editor of british medical journal. Diabetic ketoacidosis dka is a serious condition that can lead to diabetic coma passing out for a long time or even death. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are acute metabolic complications of diabetes mellitus that can occur in patients with both type 1 and 2 diabetes mellitus. Diabetic ketoacidosis dka and hyperosmolar hyperglycemic state hhs, also known as hyperosmotic hyperglycemic nonketotic state hhnk are two of the most serious acute complications of diabetes. Diabetic ketoacidosis dka is an acute diabetic complication that is due to. Diabetic ketoacidosis symptoms, diagnosis and treatment. The pathophysiology of diabetic ketoacidosis includes all of the unhealthy chemical reactions that occur in the body because of hormone release and uncontrolled elevated blood sugar.
Diabetic ketoacidosis dka is an acute, major, lifethreatening complication of diabetes that mainly occurs in patients with type 1 diabetes, but it is not uncommon in some patients with type 2 diabetes. Insulin deficiency, increased insulin counterregulatory hormones cortisol, glucagon, growth hormone, and catecholamines and peripheral insulin resistance lead to hyperglycemia, dehydration, ketosis, and electrolyte imbalance which underlie the pathophysiology of dka. Signs and symptoms of dka associated with possible intercurrent infection are as follows. Learn the pathophysiology behind the disease process, and then use that knowledge to remember how to. Such factors can include inappropriate use of insulin non. Descriptionetiology lesson quick diabetic ketoacidosis in. D iabetic ketoacidosis dka and hyperosmolar hyperglycemic state hhs are acute and potentially lifethreatening complications of diabetes.
Diabetic ketoacidosis also known as dka is one of those harder topics to learn in nursing school. There isnt enough insulin because the body cant produce it like what happens during type. Ketonuria may persist for more than 36 hours due to the slower removal of acetone. Signs and symptoms may include vomiting, abdominal pain, deep gasping breathing, increased urination, weakness, confusion and occasionally loss of consciousness. In order to understand the pathophysiology of diabetic ketoacidosis, youll need to understand the pathophysiology of diabetes as well. Heres a quick outline of the pathophysiology of dka, in simple steps for you to follow you wont find these steps in your textbook, i put it together this way to make learning it easier for you. Aims despite an increasing number of reports of ketoacidosis in populations with type 2 diabetes mellitus, the pathophysiology of the ketoacidosis in these patients is unclear. If a patient has elevated bgl and ketones but is not acidotic they need to be closely monitored and agressively managed to prevent progression to dka. It could be lifethreatening, but it usually takes many hours to. Diabetic ketoacidosis pathophysiology pdf diabetestalk. They are part of the spectrum of hyperglycemia, and each represents an extreme in the spectrum. Without insulin, glucose will not be transported to the cells. It is characterised by absolute insulin deficiency and is the most common acute hyperglycaemic complication of type 1 diabetes mellitus. Pathophysiology dka results from insulin deficiency from.
Diabetic ketoacidosis dka is a common and potentially lifethreatening complication of diabetes mellitus, the second most common chronic childhood disease 1. Pathophysiology and treatment diabetic ketoacidosis dka, also known as diabetic acidosis or diabetic coma, is a severe complication of diabetes mellitus dm. Ketoacidosis refers to diabetic ketoacidosis dka and is a complication of type 1 diabetes mellitus. Diabetic ketoacidosis an overview sciencedirect topics. Type 1 diabetes is the result of an autoimmune reaction to proteins of.
Diabetic ketoacidosis is an infrequent but lifethreatening acute complication of diabetes, affecting predominantly patients with type 1 diabetes, children, and pregnant women, where ketosis is. Diabetic ketoacidosis and hyperglycemic hyperosmolar state. Despite the similarity in name, ketosis and ketoacidosis are two different things. Common symptoms and signs include polyuria, polydipsia, polyphagia, weakness, weight loss, tachycardia, dry mucous membranes, poor skin turgor, hypotension, and, in s.
And all of these can be tricky to learn as a nursing student. Pathophysiology of diabetic ketoacidosis request pdf. Diabetic ketoacidosis is a serious complication of diabetes mellitus type 1. Insulin deficiency is the main precipitating factor. Esrd due to resolving ketoacidosis after gap is closed. Diabetic ketoacidosis dka is an extreme metabolic state. The problem in diabetes mellitus type 1 is the absolute lack of insulin. Diabetes is a group of metabolic disorders characterized by a chronic hyperglycemic condition resulting from defects in insulin secretion, insulin action or both. Having an understanding of its pathophysiology, a consequence of absent to low insulin levels, delineates the clinical presentation. Dka usually occurs as a consequence of absolute or relative insulin deficiency that is accompanied by an increase in counterregulatory hormones ie, glucagon, cortisol, growth hormone, epinephrine. While ketosis refers to any elevation of blood ketones, ketoacidosis is a specific pathologic condition that results in changes in blood ph and requires medical attention. Ketoacidosis is a metabolic state caused by uncontrolled production of ketone bodies that cause a metabolic acidosis.
Typically, patients with type 1 diabetes are more likely to exhibit. Diabetic ketoacidosis diabetic ketoacidosis dka is a state of uncontrolled diabetes and it is characterized by hyperglycemia, a high anion gap acidosis, and the presence of ketonemia and ketonuria ketone bodies in the blood and urine. Diabetic ketoacidosis dka is most common among patients with type 1 diabetes mellitus and develops when insulin levels are insufficient to meet the bodys basic metabolic requirements. Diabetic ketoacidosis dka is an acute metabolic complication of diabetes that is potentially fatal and requires prompt medical attention for successful treatment.
Euglycemic diabetic ketoacidosis induced by sglt2 inhibitors. We therefore tested the roles of three possible mechanisms. Diabetic ketoacidosis can occur in persons of all ages. Although it can occur in patients with type 2 diabetes during periods of severe. Dka results from insulin deficiency from newonset diabetes, insulin noncompli ance, prescription or illicit drug use, and.
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