Diabetic ketoacidosis dka and hyperosmolar hyperglycaemic state hhs are acute severe metabolic complications of uncontrolled diabetes mellitus. Diabetic ketoacidosis dka is characteristically associated with type 1 diabetes. Diabetic ketoacidosis simple english wikipedia, the free. Alrighty, so step one of the pathophysiology of dka is there is not enough insulin. Diabetic ketoacidosis dka is a medical emergency that can happen in people with diabetes mellitus. Pathophysiology of diabetic ketoacidosis dka and of h.
Our goal was to describe our longterm experience in the management of. Pathophysiology of diabetic ketoacidosis dka and of h openi. The criteria for hyperglycemic hyperosmolar state hhs include. The prognosis of dka is substantially worse at the extremes of age and in the presence of coma and hypotension. Nurse practitioners are well positioned to promote patient education, selfmanagement, and individualized patient care. It is necessary for clinicians to understand the pathophysiology and treatment of dka to care for this increasing diabetic population. Diabetic ketoacidosis pathophysiology pdf diabetestalk. Diabetic ketoacidosis dka remains a significant complication of diabetes in both the united states and around the world. Dka happens mostly in people with type 1 diabetes, although it may happen in some people that have type 2 diabetes dka happens when a person does not have enough insulin in their body. All of the cells in the body need glucose sugar to survive, because the body needs sugar to make energy.
Pathophysiology of diabetic ketoacidosis diabetes library. Dka can present as severe, pseudosurgical abdominal pain. Diabetic ketoacidosis symptoms, diagnosis and treatment. It occurs when absolute or relative insulin deficiency inhibits the ability of glucose to enter cells for utilization as metabolic fuel, the result being that the liver rapidly breaks down fat into ketones to employ as a fuel source. May 31, 2019 diabetic ketoacidosis dka is an acute, major, lifethreatening complication of diabetes characterized by hyperglycemia, ketoacidosis, and ketonuria. Give some form of normal saline and when serum glucose reaches 200 mgdl dka or 300 mgdl hhs, give d5w with ns bicarbonate. Having an understanding of its pathophysiology, a consequence of absent to low insulin levels, delineates the clinical presentation. Diabetic ketoacidosis is an acute metabolic complication of diabetes characterized by hyperglycemia, hyperketonemia, and metabolic acidosis. Dka features hyperglycemia, acidosis, and high levels of. Oct 24, 2017 diabetic ketoacidosis one of the hyperglycemic crises, dka, pathophysiology, causes, clinical presentation signs and symptoms and treatment. Pathophysiology diabetic ketoacidosis dka is a complex disordered metabolic state characterised by hyperglycaemia, acidosis, and ketonaemia. They are potentially lifethreatening and require swift recognition and treatment. Signs and symptoms of diabetic ketoacidosis dka children.
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 and hyperosmolar hyperglycemic. It is characterised by absolute insulin deficiency and is the most common acute hyperglycaemic complication of type 1 diabetes mellitus. Diabetic ketoacidosis dka is traditionally considered a key clinical feature of type 1 diabetes mellitus t1dm. 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 pathophysiology, animation youtube.
Definition dka is defined as the presence of all three of the following. Mar 19, 2019 professional reference articles are designed for health professionals to use. Management of an episode of dka is not complete until an attempt has been made to identify and treat the cause. Diabetic ketoacidosis dka is an emergency for people with diabetes characterized by hyperglycemia, metabolic acidosis, and ketosis. Generally speaking, dka affects people with type 1 diabetes. This article outlines updates in the clinical management of. Dka features hyperglycemia, acidosis, and high levels of circulating ketone bodies.
Dka usually occurs as a consequence of absolute or relative insulin deficiency that is accompanied by an increase in counter. They are written by uk doctors and based on research evidence, uk and european guidelines. Diabetic ketoacidosis dka represents a profound insulindeficient state characterized by hyperglycemia 200 mgdl 11. It causes nausea, vomiting, and abdominal pain and can progress to. Diabetic ketoacidosis can occur in persons of all ages. You may find one of our health articles more useful. More commonly seen in patients with type 1 diabetes t1d, dka results when lipid breakdown generates a surplus of acidic. Mar 29, 2018 diabetic ketoacidosis is an acute metabolic complication of diabetes characterized by hyperglycemia, hyperketonemia, and metabolic acidosis. Before the availability of insulin in the 1920s, dka was a uniformly fatal disorder. Nelson, in canine and feline endocrinology fourth edition, 2015.
Even after the discovery of insulin, dka continued to carry a grave prognosis with a reported mortality rate in humans ranging from 10% to 30%. Diabetic ketoacidosis dka is the commonest endocrine emergency encountered in clinical practice. Signs and symptoms of dka include frequent urination, increased thirst, increased hunger, unexplained weight loss and flulike symptoms. Although it can occur in patients with type 2 diabetes during periods of severe. Diabetes ketoacidosis dka pathophysiology youtube essential pathophysiology of dka and eudka consequent to the use. Prevention of dka is the ultimate goal 80% of hospital admissions for dka occur in treated diabetics 3,8. Pathophysiology of diabetic ketoacidosis diabetic ketoacidosis is one of the potentially lifethreatening acute complications of diabetes mellitus.
Rarely, a primary cns infection, such as bacterial. Management of diabetic ketoacidosis in children and. We discuss the pathophysiology of diabetic ketoacidosis, its management, and its complications. Diabetic ketoacidosis dka in patients with type 1 diabetes is a medical emergency that may present with neurologic signs and symptoms.
Diabetic ketoacidosis dka is the result of insulin deficiency from newonset diabetes usually type 1 diabetes, insulin noncompliance, prescription or illicit drug use, and increased insulin need because of any condition. Recurrent dka without a preceding febrile or vomiting illness is almost always the result of psychosocial problems and failure to take insulin e. Diabetic ketoacidosis remains a significant complication of diabetes in both the united states and worldwide with its associated high rates of hospital admissions. Dka accounts for more than 150,000 hospital admissions per year in the. Diabetic ketoacidosis dka is an acute, major, lifethreatening complication of diabetes characterized by hyperglycemia, ketoacidosis, and ketonuria. Hyperglycemic hyperosmolar syndrome used to be called honk hyperosmolar nonketotic dka and hhs absence of insulin increased glucagon increased diabetogenic hormones oxidation of free fatty acids ketones. Current concepts of the pathogenesis and management of. Updates in the management of diabetic ketoacidosis the. A female patient lal mai was admitted to the medical ward 4 of bvh and was suffering from pain in right hypochondrium and diabetic ketoacidosis. Each of these documents is also available individually for download from our website. Dehydration may be great in diabetic ketoacidosis, and intravenous fluids are usually needed as part of its. Its much rarer for people with type 2 diabetes to develop dka, since they usually have some remaining insulin production.
Diabetic ketoacidosis dka is the most common hyperglycemic emergency in patients with type 1 and type 2 diabetes mellitus. Dka has similar symptoms as some common illnesses, which can make it hard to detect, says dr. Oct 30, 2014 coverhydration and acute pulmonary edema. Diabetic ketoacidosis dka is a frequent abnormal metabolic entity seen in highdependency units such as critical care units and in the emergency department.
Complete description of the pathophysiology of diabetic. Diabetic ketoacidosis and hyperglycemic hyperosmolar state. Insulin deficiency is the main precipitating factor. Whatyoushouldknow diabeticketoacidosis dka isacommon,serious,andpreventablecomplicationoftype1diabetes,withamortalityof35%. Mortality in dka is primarily due to the underlying precipitating illness and only rarely due to the metabolic complications of hyperglycemia or ketoacidosis. In new onset diabetes, dka is frequently the consequence of a delay in diagnosis e. Know the signs and make sure to talk to your childs doctor about these symptoms if you are concerned.
Diabetic ketoacidosis dka is a serious complication of diabetes mellitus. Although in the last 3 decades the average worldwide immediate mortality has decreased from 10% to 5%, survival has not improved strikingly. Dka onset and recurrence can largely be prevented through patient education. Definition of dka dka diabetic ketosis acidosis diabetes kills animals definitions dka.
Potential complications include cerebral edema, hypokalemia, hypoglycemia, and relapse. Diabetic ketoacidosis dka society of hospital medicine. Dka is a severe metabolic derangement characterized by dehydration, loss of electrolytes, hyperglycemia, hyperketonemia, acidosis and progressive loss of consciousness that results from severe insulin deficiency combined with the effects of increased levels of counterregulatory hormones catecholamines, glucagon, cortisol, growth hormone. And if you want to know more about diabetic ketoacidosis, you can click the button above to download a free dka study guide. Management of diabetic ketoacidosis in children and adolescents.
So lets get into the nitty gritty of the pathophysiolog of diabetic ketoacidosis. Diabetic ketoacidosis is characterized by a serum glucose level greater than 250 mg per dl, a ph less than 7. The proper management of dka requires intense monitoring and clear understanding of pathophysiology related to it. Diabetic ketoacidosis diabetic ketoacidosis dka ketonuria.
Diabetic ketoacidosis dka is an acute metabolic complication of diabetes that is potentially fatal and requires prompt medical attention for successful treatment. Diabetic ketoacidosis dka is a rare yet potentially. Metabolic acidosis pathophysiology pdf diabetestalk. Presence of leukocytosis initially in dka is due to. Dka without a preceding febrile illness or gastroenteritis in a patient with known diabetes is almost always the result of psychosocial problems and failure to appropriately administer insulin. 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. Management of adult diabetic ketoacidosis aidar r gosmanov,1 elvira o gosmanova,2 erika dillardcannon3 1division of endocrinology, diabetes and metabolism, 2division of nephrology, department of medicine, 3department of microbiology, immunology, and biochemistry, university of tennessee health science center, memphis, tn, usa abstract. Therefore, it becomes vital that the healthcare professional be able to manage the hyperglycemic crises. Hyperglycemia causes an osmotic diuresis with significant fluid and electrolyte loss. Diabetic ketoacidosis dka, hyperglycemic hyperosmolar. Diabetic ketoacidosis and hyperosmolar crisis in adults. Results for dka pathophysiology 1 10 of 37 sorted by relevance date click export csv or ris to download the entire page or use the checkboxes to select a subset of records to download.
Dka pathophysiology diabetic ketoacidosis algorithm dka usama nasir md. Pathophysiology and treatment diabetic ketoacidosis dka, also known as diabetic acidosis or diabetic coma, is a severe complication of diabetes mellitus dm. Somewhere between 5 and 8 of every 1,000 people with type 1 diabetes develops dka each year, resulting in about 5,000 hospital admissions per year. In the past, diabetic ketoacidosis was considered as the hallmark of type i diabetes, but current data show that it can be also diagnosed in patients with type ii diabetes mellitus. 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. Pathophysiology of diabetic ketoacidosis 2018 nursing. Diabetic ketoacidosis an overview sciencedirect topics. It also occurs in type 2 diabetes under conditions of extreme stress such as serious infection, trauma, cardiovascular or other emergencies, and, less often, as a presenting manifestation of type 2 diabetes, a disorder called ketosisprone diabetes mellitus.