Diabetic Ketoacidosis (DKA) Mona Omran, Jung Eun Lee, Tiffany Ou, Annie Yan PHM142 Fall 2015...
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Transcript of Diabetic Ketoacidosis (DKA) Mona Omran, Jung Eun Lee, Tiffany Ou, Annie Yan PHM142 Fall 2015...
Diabetic Ketoacidosis (DKA)Mona Omran, Jung Eun Lee, Tiffany Ou, Annie Yan
PHM142 Fall 2015Coordinator: Dr. Jeffrey HendersonInstructor: Dr. David Hampson
Introduction
• Life-threatening condition that arises when cells in the body are unable to get glucose they need for energy due to insufficient amount of insulin
• The body begins to break down fat and muscle for energy
• Ketones or fatty acids are produced
• They enter the bloodstream and make it more acidic
Causes
• Most susceptible people are those with Type 1 diabetes but it can happen with Type 2 diabetes
• Not enough food, having a severe infection or other illness, missed insulin treatment or becoming severely dehydrated
Symptoms
• Evidence of dehydration (dry mouth and decreased skin turgor)• Often, a "ketotic" odour ( "fruity“)• Nausea, vomiting, generalized weakness, confusion, abdominal
tenderness and shortness of breath
Diagnosis
• Blood and urine tests for Ketone and glucose.
• The acceptable range for blood ketones is less than 0.6 mmol/L.
• If Blood glucose levels are consistently greater than 14 mmol/L for more than 1 day and blood ketones between 1.5 and 3.0 mmol/L.
• Decrease in the circulating blood volume, tachycardia and low blood pressure.
Hormonal Control of Blood Glucose
• Insulin • Glycogen production• Fat (Triglyceride) Production
• Glucagon • Glycogen breakdown• Amino Acid breakdown• Fat breakdown
Ketone Body: Formation and Consequences3 types of “Ketone Bodies”
• Good for periods of starvation…
3-HB Dehydrogenase
Reduction Rxn
SpontaneousDecarboxylation
+H+
Ketone Body Metabolism during DKA
Treatment
Resolving Dehydration:• Recommended 0.9% NaCl IV bolus to improve plasma
osmolarity
Insulin Therapy:• Encourage glucose uptake in peripheral tissues and decrease
gluconeogensis and glycogenolysis
Treatment
Electrolyte Therapy:• K+ IV supplement required to avoid arrhythmias and cardiac
arrest
• Bicarbonate therapy for severe ketoacidosis (pH<6.9)
• Phosphate therapy can be given (blood level < 10ml/dL) if phosphate and calcium levels are closely monitored
Prevention
Type 1 Diabetes:• No current, safe preventive measures
Type 2 Diabetes:• Lifestyle changes
• Lower calorie and fat intake• Reduce sugar in diet• Increase fibre intake• Exercise -- recommended 150 minutes of ‘moderate’ or higher intensity of
physical activity
Prevention
Type 2 Diabetes:• Drugs that can prevent the progression from pre-diabetes
to diabetes:• Metformin
• Decreases liver production of glucose (i.e. decreases conversion of glycogen to glucose)
• Reduces absorption of glucose at intestinal level (i.e. lowers amount of glucose to get into the body)
• Exact mechanism unknown
Prevention
• Early detection of onset of diabetic ketoacidosis through:• Close and continuous monitoring of glucose levels and ketone levels
through analysis of blood or urine• Identifying at-risk individuals (by health care providers)
• Educating the patient
• Increasing awareness and knowledge in the community
Conclusion
• Diabetes Ketoacidosis is a potentially lethal complication of diabetes (both type 1 and 2) where there is:
• increased level of ketone bodies• a drop in pH
• Variety of physiological effects
• Treatments are available but prevention would be best
Summary Slide• Diabetic ketoacidosis is a serious complication of diabetes.
• It is characterized by evidence of high blood glucose and ketone levels.
• High glucagon:insulin ratio leads to accumulation of ketone bodies leading to several
pathophysiology
• hyperglycemia, electrolyte imbalance, dehydration, and decrease in blood pH.
• The three main ketone bodies made are: acetoacetate, acetone, 3-Beta-
Hydroxybutyrate. These are formed in liver mitochondria
• Treatment: Saline (NaCl) infusion, K+ infusion, insulin therapy
• Prevention: Lifestyle changes (eating healthier + exercise), metformin
ReferencesCanadian Diabetes Association Clinical Practice Guidelines Expert Committee. (2013). Canadian Diabetes Association 2013 Clinical
Practice Guidelines for the Prevention and Management of Diabetes in Canada. Canadian Journal of Diabetes 2013, 37(suppl 1), S1-S212.
Casteels, K., & Mathieu, C. (2003). Diabetic ketoacidosis. Reviews in Endocrine and Metabolic Disorders, 4(2), 159-166. doi:10.1023/A:1022942120000
Gosmanov, A. R., Gosmanova, E. O., & Dillard-Cannon, E. (2014). Management of adult diabetic ketoacidosis. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 7, 255–264.
Lebovitz, H. E. (1995). Diabetic ketoacidosis. The Lancet, 345(8952), 767-772.
Laffel, L. 'Ketone Bodies: A Review of Physiology, Pathophysiology and Application of Monitoring to Diabetes', Diabetes Metab Res Rev, 15 (1999), 412-26.
Rewers, A. (2010). Current controversies in treatment and prevention of diabetic ketoacidosis. Advances in Pediatrics,57(1), 247-267. doi:10.1016/j.yapd.2010.09.001
Wolfsdorf et al. (2007). Diabetic ketoacidosis. Pediatric Diabetes, 8, 28-43. doi: 10.1111/j.1399-5448.2007.00224.x