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Diabetic ketoacidosis

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Diabetic ketoacidosis (DKA) is a serious complications of untreated diabetes. In this complication, insufficient insulin levels in the body results into high blood sugar that leads to the buildup of substances called ketones in the blood (called ketoacidosis in medical terms). If remained untreated, the condition leads to diabetic coma and may be fatal. Diabetic ketoacidosis (DKA) gets triggered by a stressful event like an illness or other health problems. DKA is more common in people with type 1 diabetes. In some cases, identification of DKA is the first indication that a person has a diabetes.

Signs & SymptomsEdit

Early
  • Sluggish, extreme tiredness.
  • Fruity smell to breath/compare to nail polish remover
  • Extreme thirst, despite large fluid intake.
  • Constant urination/bedwetting.
  • Extreme weight-loss
  • Presence of Oral Thrush or yeast infections that fail to go away - this is because the normal fungal/flora present in oral cavity/cervix in women, the balance is upset and bacterial began to feast on the high sugar from urine output/ dry mouth from extreme thirst.
  • Muscle wasting
  • Agitation / Irritation / Aggression / Confusion
Late

At this stage, Diabetic ketoacidosis reaches life-threatening level:

  • Vomiting, although this can be a sign of hyperglycemia and isn't always a late stage sign, in fact can happen whether ketoacidocis is present or not
  • Confusion
  • Abdominal pain
  • Loss of appetite
  • Flu-like symptoms
  • Unconsciousness (diabetic coma)
  • Being lethargic and apathetic
  • Extreme weakness
  • Kussmaul breathing/air hunger - in this condition, patients breath more deeply and/or more rapidly)

Risk factorsEdit

The major risk factors accelerating on set of diabetic ketoacidosis include the following:

  • Diabetes mellitus: mainly type 1 diabetes though it also occurs in people with type 2 diabetes, especially in obese children.
  • Age: DKA may occur at any age but younger people below 19 years of age are more susceptible.
  • Short acting insulin devices: It is active in the body only for few hours, and its malfunctioning induces the drop of insulin level in the blood that results into diabetes related complications including DKA.

CausesEdit

Around 10 percent of persons with diabetes don't have any specific and identifiable cause for developing diabetic ketoacidosis though occurrence of this condition is prevalent in persons with diabetes. People with diabetes don't have hormone insulin that is required to load the cells with glucose which they use as energy. In the absence of sufficient insulin, even excessive sugar in the glucose serve no purpose and the cells remain "hungry" of glucose. This depletes the energey reserves of the body, and body releases hormones to break down fats stored in the body for energy requirements of the body. This breaking down process create acids known as ketones. Large quantity of ketones upset the vital balances in the blood and is toxic to the blood. Further, events which are stressful can also result into diabetic ketoacidosis - stress prompts and accelerates the release of excessive amounts of hormones that break down fat into glucose. Excessive amounts of these hormones negatively impacts the ability of insulin to assist smoothly the uptake of glucose into the cells. The combination of all these factors result into diabetic ketoacidosis.

Many times, daiabetic ketoacidosis (DKA) also gets triggered by one or more health problems like infection, for example, pneumonia or urinary tract infections. Inadequate or improper insulin therapy also triggers DKA. Other causes of DKA include:

  • Insufficient intake of fluid, particularly during hot weather,
  • Heart attack and/or stroke,
  • Alcohol and/ or drug abuse,
  • Pancreatitis, that is, an inflammation of the pancreas, and
  • Physical or emotional trauma.

PreventionEdit

  • Monitoring blood sugar and ketone levels: Regular monitoring blood sugar and ketone levels are essential steps to prevent development of diabetic ketoacidosis. This is more important during any sort of infection, trauma, excessive stress due to any reason. Such a monitoring is also essential by pregnant women with diabetes (or even without diabetes). If the bllod sugar level is found to exceed persistently beyond 300 mg/dL, medical consultation is necessary.
  • Assessing and evaluation of diabetic condition: This is also a necessary part of any prevention program. Diabetic ketoacidosis may arise on account of irregular or insufficient insulin treatment. In order to rectify the situation, suitable alteration may be required, in consultation with medical care personnel, to alter the insulin treatment to give better results.
  • Prompt and proper medical consultation: Any unusual signs and symptoms such as vomiting, confusion, elevated blood sugar levels, stomach pain, etc. indicate that medical consultation is urgently required. Diabetic ketoacidosis may turn fatal if remaining untreated.

ComplicationsEdit

Persons with diabetic ketoacidosis (DKA) require very frequent monitoring to watch the complications. Most of the complications of DKA are related to its treatment which pose a rather difficult position to control the complications. The three major complications of diabetic ketoacidosis are:

  • Hypoglycemia: Hypoglycemia indicates blood sugar level that is below the normal lows. With insulin treatment, cells become active and picks up the sugar fast that causes the blood sugar level to drop rapidly. Any quick drop of blood sugar results into hypoglycemia.
  • Hypokalemia: Hypokalemia indicates a very low level of the electrolyte potassium in the blood. Insulin treatment infuses sufficient insulin in the blood at one stroke, insulin and fluids helps in the entry of potassium into the cells, which decreases and depletes the level of potassium in the blood. Continuously low level of potassium in blood can impari muscle, activities of nerve, and can also impair heart.
  • Cerebral edema: It is a rare complication of diabetic ketoacidosis. In cerebral edema, brain swelling takes place on account of buildup of fluid in the brain cells. A rare complication, cerebral edema is brain swelling caused by a buildup of fluid in the brain cells. It's not certain why treatment causes cerebral edema to develop, although it may be related to rapid fluid replacement. Cerebral edema most frequently occurs in children.

TreatmentEdit

DKA - Diabetic ketoacidosis requires urgent treatment immediately after it is diagnosed. Treatment involves fluid replacement, electrolyte replacement, and intravenous insulin therapy. After initial treatment, the health care personnel tries to understand the exact reason that caused the DKA to plan further course of action - for instance, if it was triggered by heart attack, further evaluation of heart condition is done or if it was triggered by infection, the nature of infection is examined and antibiotics may be prescribed.

External linksEdit

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