Diabetic ketoacidosis arises because of a lack of insulin in the body. The lack of insulin and corresponding elevation of glucagon leads to increased release of glucose by the liver (a process that is normally suppressed by insulin) from glycogen via glycogenolysis and also through gluconeogenesis.
What is the physiologic basis of diabetic ketoacidosis?
DKA happens when the signal from insulin in the body is so low that: Glucose (blood sugar) can’t go into cells to be used as a fuel source. The liver makes a huge amount of blood sugar. Fat is broken down too rapidly for the body to process.
What are pathophysiological changes in DKA?
Pathogenesis and Pathophysiology
In DKA, the normal state of carbohydrate metabolism (driven by insulin) shifts to a starvation state and fat metabolism, leading to the characteristic abnormalities, including hyperglycemia, ketoacidosis, hyponatremia, polyuria, and polydipsia.
What happens to the body during DKA?
Diabetic ketoacidosis (DKA) is a serious condition that can lead to diabetic coma (passing out for a long time) or even death. When your cells don’t get the glucose they need for energy, your body begins to burn fat for energy, which produces ketones.
What causes Kussmaul breathing?
Causes: Kussmaul breathing is usually caused by high acidity levels in the blood. Cheyne-Stokes breathing is usually related to heart failure, stroke, head injuries, or brain conditions. Pattern: Kussmaul breathing doesn’t alternate between periods of fast and slow breathing.
Why is bun high in DKA?
Initial evaluation and monitoring of suspected diabetic ketoacidosis – BUN level is usually mildly to moderately elevated (mean 32 mg/dL) in diabetic ketoacidosis (DKA), attributable to significant volume loss rather than diabetic nephropathy.
What is the pathophysiology of hyperosmolar hyperglycaemic acidosis?
Pathophysiology. Elevated levels of counterregulatory hormones (glucagon, catecholamines, cortisol, and growth hormone) initiate HHS by stimulating hepatic glucose production through glycogenolysis and gluconeogenesis, leading to hyperglycemia, intracellular water depletion, and subsequent osmotic diuresis.
What is the pathophysiology of HHS?
HHS occurs when the blood sugar of a person with diabetes becomes too high (hyperglycemia) for a long time. The extra sugar is passed into the urine, which causes the person to urinate frequently. As a result, he or she loses a lot of fluid, which can lead to severe dehydration (extreme thirst).
What is hyperosmolar coma?
Hyperosmolar coma is also referred to as hyperosmolar hyperglycemic syndrome (HHS) or nonketotic hyperglycemic syndrome. It is characterized by severe hyperglycemia, hyperosmolality, and dehydration in the absence of significant ketoacidosis. Hyperosmolar coma and diabetic ketoacidosis (DKA) are hyperglycemic crises.
How is ketoacidosis diagnosis?
A diagnosis of diabetic ketoacidosis requires the patient’s plasma glucose concentration to be above 250 mg per dL (although it usually is much higher), the pH level to be less than 7.30, and the bicarbonate level to be 18 mEq per L or less.
Does DKA cause hyperkalemia or hypokalemia?
DKA is a well-known cause of hypokalemia caused by osmotic diuresis leading to a total body potassium deficiency of 3 to 6 mEq/kg. At presentation, potassium levels are typically “normal” due to the extracellular shift of potassium (K+) from insulin deficiency and acidosis.
What are the diagnostic criteria for DKA?
The diagnostic criteria for diabetic ketoacidosis are: ketonaemia 3 mmol /l and over or significant ketonuria (more than 2 + on standard urine sticks) blood glucose over 11 mmol /l or known diabetes mellitus. venous bicarbonate (HCO3 ) ) below 15 mmol /l and /or venous pH less than 7.3 (1)
What are Cheyne-Stokes respirations?
Cheyne-Stokes respiration is a specific form of periodic breathing (waxing and waning amplitude of flow or tidal volume) characterized by a crescendo-decrescendo pattern of respiration between central apneas or central hypopneas.
What is guppy breathing?
Agonal breathing, or agonal respiration, is the medical term for the gasping that people do when they’re struggling to breathe because of cardiac arrest or another serious medical emergency.
What is Unlabored breathing?
(of breathing) relaxed or natural; not performed with difficulty.