Diabetic Ketoacidosis DKA
OVERVIEW.
Pathophysiology Causes, signs & Symptoms..
Diabetic Ketoacidosis (DKA) is a serious and potentially life-threatening complication of diabetes. It occurs when there is a shortage of insulin in the body, leading to high blood sugar levels and the breakdown of fat cells to produce energy. This process results in the release of ketones into the bloodstream, which can lead to an imbalance in the body's pH levels and cause a range of symptoms.
DKA is most commonly seen in people with type 1 diabetes, but it can also occur in people with type 2 diabetes who have an insulin deficiency. Some common triggers for DKA include illness, infection, or a missed insulin dose.
Symptoms of DKA can include excessive thirst and urination, abdominal pain, nausea and vomiting, weakness and fatigue, rapid breathing, and confusion or unconsciousness. If left untreated, DKA can lead to severe dehydration, coma, or even death.
Treatment for DKA typically involves administering insulin to lower blood sugar levels and rehydrating the body with fluids and electrolytes. Hospitalization may be necessary in severe cases, and close monitoring of blood sugar levels and electrolyte levels is crucial..png)
.png)
Prevention of DKA involves careful management of diabetes, including regular monitoring of blood sugar levels, adherence to insulin therapy, and prompt treatment of any infections or illnesses. It's important for people with diabetes to be aware of the symptoms of DKA and seek medical attention immediately if they suspect they may be experiencing it.
Before looking into diabetic ketoacidosis let's brief about diabetes mellitus diabetes mellitus is a group of metabolic diseases characterized by elevated levels of glucose in the blood that is hyperglycemia resulting from defects in insulin secretion or insulin action or both as we all know insulin is a hormone which is produced by the pancreas. It controls the level of glucose in the blood and regulates the production and storage of glucose now what happens in the diabetic state is either the cells may stop responding to insulin or the pancreas may stop producing insulin entirely and this leads to hyperglycemia which may result in acute metabolic complications such as diabetic ketoacidosis that is DKA and hyperglycemic hyperosmolar non-ketotic syndrome that is hhns.
Diabetic ketoacidosis…
Diabetic ketoacidosis is a serious life-threatening complication of diabetes. Diabetic ketoacidosis is most common among people with type 1 diabetes people, with type 2 diabetes can also develop decay.
The main reason why diabetic ketoacidosis develops is when the body doesn't have enough insulin to allow blood sugar into cells for use as energy thyroid ketoacidosis in short is called as dka is characterized by hyperglycemia keto anemia and academia and this results from disorders in the metabolism of carbohydrate-protein and fat.
let's look into the causes of diabetic ketoacidosis..png)
.png)
First comes illness..
Any illness may lead to stress sometimes being sick can cause the body to release higher amounts of certain hormones like stress hormones for example cortisol and adrenaline these hormones make it more difficult for the body to use insulin properly.
Next cause Infections..
like pancreatitis pneumonia bacteremia uti etc.
Now just like with illness infections also causes the body to release certain hormones that makes it harder to use insulin often times if there is diabetes and an infection the body needs more insulin than usual.
Next causes ischemia or infection..
Such as acute coronary syndrome critical limb ischemia or ischemic bowel and heart attack or stroke.
The next cause is drug intoxication..
For example ethyl alcohol cocaine methamphetamine etc. Which can also trigger diabetic ketoacidosis.
The next cause may be a lack of insulin, for example, a misdose.
The next causes are iatrogenic.
Which may be secondary due to some medications like antipsychotic drugs and corticosteroids and also due to surgeries.
ketoacidosis
As pregnancy progresses mother may require more insulin which could also trigger diabetic keto acidosis.
So let's get into the pathophysiology of diabetic ketoacidosis before that first you should know about the function of insulin so that you will have a clear idea about the pathophysiology. Pancreas makes insulin and releases it into the bloodstream insulin helps to move glucose into the cells, now cells use this glucose for energy and the body stores any extra glucose in the liver muscles and fat cells, the major function of insulin includes increased glucose uptake by liver skeletal muscles and adipose tissue. So in the liver this glucose uptake enhances glycogenesis which is the formation of glycogen and in the muscle it enhances protein synthesis and in adipose tissue it enhances adipogenesis which is the formation of adipose site that is fat cells remember that this is the normal function of insulin but what happens in diabetic ketoacidosis is there is lack of insulin. This enhances glyconeogenesis which is the formation of glycogen from non-carbohydrate sources which in terms leads to hyperglycemia in muscles it enhances glyconeogenesis and in adipose tissue, it enhances lipolysis. Which is nothing but the breakdown of fat cells and also leads to the formation of ketone bodies.
So looking into the pathophysiology of diabetic ketoacidosis without insulin the amount of glucose entering the cells is reduced and the liver increases glucose production which leads to hyperglycemia.
In an atom to get rid of the body's excess glucose the kidneys excrete the glucose along with water and electrolytes, for example, sodium and potassium this osmotic diuresis is characterized by excessive urination, that is polyuria which leads to dehydration and market electrolyte loss the other effects of insulin deficiency is a breakdown of fat into free fatty acids and glycerol, which leads to free fatty acids getting converted to ketone bodies by the liver and leading to accumulation of ketone bodies in the circulation which finally leads to metabolic acidosis..png)
.png)
Let's look into the signs and symptoms.
Polyurea. as we know frequent urination polydipsia that is frequent thirst universes that is involuntary urination
Dehydration. causing tachycardia that is increased heart rate and orthostasis, Abdominal pain causing nausea and vomiting.
Fruity breath order or acetone order breath.
Next is kussmaul breathing here a low partial pressure of carbon dioxide that is 10 to 30 mmhg reflects respiratory compensation that is kussmaul respiration for the metabolic acidosis.
Next comes mental status changes such as combative where they are ready or eager to fight or argue stupor coma.
Next let's discuss about diagnostic evaluation of diabetic keto acidosis, first is history collection here we collect informations like patient is taking steroids or antipsychotic drugs any presence of illness infection or ischemia drug abuse and any surgical history.
Next comes physical examination where we see signs of dehydration like dry mucous membrane poor skin turgor small respiration acetone breath or a fruity order breath.
Next comes blood investigations where there is hyperglycemia that is blood level glucose is 300 to 400 mg per electrolyte imbalance for example sodium and potassium. which is caused because osmotic diuresis and ketone bodies are found in the blood and elevated blood urea nitrogen and creatinine. In abg, there is decreased ph, decreased level of bicarbonate, and decreased level of partial pressure of carbon dioxide and the anion gap is more than 10. In urine, there is the presence of ketone bodies and infections which is indicated by the presence of muscles.
Next, let's look into the management of diabetic ketoacidosis the important things to be done here are correction of shock and dehydration, correction of hyperglycemia, correction of deficits in electrolytes, correction of acidosis, and treatment of infection. The priorities in the management are circulation airway and breathing and after stabilizing all of this we get into controlling hyperglycemia.
Which is done by insulin administration either by bolus or continuous infusion here insulin of 0.1 unit per kg iv bolus initially is given followed by continuous iv infusion of 0.1 unit per kg per hour in 0.9 percent saline solutions and insulin should be withheld until serum potassium is more than or equal to 3.3 million equivalent per liter the very important and main management is rehydration usually patients may need up to 6 to 10 liters of iv fluid to replace fluid losses caused by polyurea hyperventilation diarrhea and vomiting.
Next is initial bowlers of isotonic saline followed by hypotonic saline solution as long as the patient is hemodynamically stable the examples are sodium chloride 0.9 percent or 0.45 percent, and plasma expanders may be necessary to correct severe hypotension that does not respond to iv fluid treatment.
Now the next main management is restoring electrolytes that is potassium correction monitor serum potassium every sixth hour where we have to closely monitor for arrhythmias too and other electrolyte deficits should also be correlated. This management is reversing acidosis ketone bodies accumulate as a result of fat breakdown the acidosis that occurs in diabetic ketoacidosis is reversed with insulin which inhibits fat breakdown thereby stopping acid buildup insulin is usually infused intravenously at a slow continuous rate for example 5 units per hour and bicarbonate infusion is also given for treating metabolic acidosis.
The important nursing diagnosis for diabetic ketoacidosis includes risk for fluid volume deficit related to risk factors like decreased intake of fluids gastric losses due to nausea and vomiting, and Hyperglycemia-induced osmotic diuresis. Here you go with diabetic ketoacidosis. Read more...
FAQ..
Q: What is diabetic ketoacidosis (DKA)?
A: DKA is a serious and potentially life-threatening complication of diabetes that occurs when there is a shortage of insulin in the body, leading to high blood sugar levels and the breakdown of fat cells to produce energy.
Q: Who is at risk for developing DKA?
A: DKA is most commonly seen in people with type 1 diabetes, but it can also occur in people with type 2 diabetes who have an insulin deficiency.
Q: What are the symptoms of DKA?
A: Symptoms of DKA can include excessive thirst and urination, abdominal pain, nausea and vomiting, weakness and fatigue, rapid breathing, and confusion or unconsciousness.
Q: What causes DKA?
A: Some common triggers for DKA include illness, infection, or a missed insulin dose.
Q: How is DKA diagnosed?
A: Diagnosis of DKA typically involves a blood test to check for high blood sugar levels and the presence of ketones in the blood or urine.
Q: How is DKA treated?
A: Treatment for DKA typically involves administering insulin to lower blood sugar levels and rehydrating the body with fluids and electrolytes. Hospitalization may be necessary in severe cases.
Q: Can DKA be prevented?
A: Prevention of DKA involves careful management of diabetes, including regular monitoring of blood sugar levels, adherence to insulin therapy, and prompt treatment of any infections or illnesses.
Q: Is DKA a medical emergency?
A: Yes, DKA is a medical emergency that requires immediate medical attention. If you suspect you may be experiencing DKA, seek medical attention immediately.
