Saturday, 9 April 2011

Diabetic Ketoacidosis Treatments

What is Diabetic Ketoacidosis?

Diabetic ketoacidosis is a diabetic complication that occurs when the body uses fat instead of glucose as a fuel source because the body does not have enough insulin. Ketones, (byproducts of fat breakdown) build up in the body.

Causes, incidence, and risk factors Of Diabetic Ketoacidosis

People with type 1 diabetes lack a hormone in the body used to process glucose (blood sugar) for energy. When glucose is not available, body fat is broken down for this energy instead.

As these fats are broken down, a type of acid called ketones build up in the blood and urine. In excessive levels, ketones are poisonous, This condition is known as ketoacidosis.

Blood glucose levels rise (usually higher than 300 mg/dL) because the liver produces glucose to try to combat the problem. However the cells cannot pull in that glucose without insulin.

Diabetic ketoacidosis may lead to a diagnosis of type 1 diabetes, because it is often the first symptom that causes a person to see a doctor. It can also be the result of increased insulin needs in someone already diagnosed with type 1 diabetes.

Infection, trauma, heart attack, or surgery can lead to diabetic ketoacidosis in such cases. Missing doses of insulin can also lead to ketoacidosis in people with diabetes.

People with type 2 diabetes can develop ketoacidosis, but it is rare. It is usually triggered by a severe illness. People of Hispanic and African-American ethnicity seem to be more likely to have ketoacidosis as a complication of type 2 diabetes.

Symptoms Of Diabetic Ketoacidosis

The warning signs that you are becoming very sick might include:
  • Deep, rapid breathing
  • Dry skin and mouth
  • Flushed face
  • Fruity breath (breath odor)
  • Nausea and vomiting
  • Stomach pain
Other symptoms that can occur include:
  • Fatigue
  • Frequent urination or thirst for a day or more
  • Mental stupor that may progress to coma
  • Muscle stiffness or aching
  • Shortness of breath
  • Abdominal pain
  • Breathing difficulty while lying down
  • Decreased appetite
  • Decreased consciousness
  • Headache

Symptoms and Testing for Diabetic Ketoacidosis

Ketone testing may be used in type 1 diabetes to screen for early ketoacidosis. The ketones test is done using a urine sample. Ketone testing is usually done at the following times:

  • When the blood sugar is higher than 240 mg/dL
  • During an illness such as pneumonia, heart attack, or stroke
  • When nausea or vomiting occur
  • During pregnancy
Other tests that may be done to diagnose ketoacidosis include:
  • Arterial blood gas
  • Blood glucose test
  • Blood pressure measurement
  • Amylase blood test
  • Potassium blood test

This disease may also affect the results of CO2 tests, CSF collection, potassium urine tests, magnesium phosphorus and sodium blood tests, sodium urine test and urine pH.

Diabetic Ketoacidosis Treatment

The goal of Diabetic Ketoacidosis treatment is to correct the high blood glucose level by giving the patient more insulin. Equally important is to replace fluids lost through excessive vomiting and urination. You may be able to recognize the early warning signs and make appropriate corrections at home before the condition gets worse. Most of the time, you will need to go to the hospital. At the hospital, an insulin replacement will be given, fluids and electrolytes will be replaced and the  cause of the condition (such as infection) will be found and treated.

Expectations Of Diabetic Ketoacidosis

Acidosis can lead to severe illness or death. Improved therapy for young people with diabetes has decreased the death rate from this condition. However, it remains a significant risk in the elderly, and in people who fall into a coma when treatment has been delayed.

Complications of Diabetic Ketoacidosis include a buildup of fluid in the brain, heart attack and death of bowel tissue due to low blood pressure or renal failure.


This condition can become a medical emergency. Call your health care provider if you notice early symptoms of diabetic ketoacidosis. Be sure to go to the emergency room or call the local emergency number if you experience decreased consciousness, difficulty breathing, fruity breath, mental stupor, nausea or vomiting

Prevention Of Diabetic Ketoacidosis 

People with diabetes should learn to recognize the early warning signs and symptoms of ketoacidosis. In people with infections or who are on insulin pump therapy, measuring urine ketones can give more information than glucose measurements alone.
Insulin pump users need to check often to see that insulin is still flowing through the tubing, and that there are no blockages, kinks, or disconnections.

References

1.Eisenbarth GS, Polonsky KS, Buse JB. Type 1 Diabetes Mellitus. In: Kronenberg HM, Melmed S, Polonsky KS, Larsen PR. Kronenberg: Williams Textbook of Endocrinology. 11th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 31.

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