Complications of Diabetic Ketoacidosis

The blood glucose level has very limited range for humans to survive and stay healthy. Generally, people are able to remove excess glucose rapidly from the body but this is not the case when they are diagnosed with diabetes and insulin resistant situations. The lack of insulin resistance can also lead to a decrease in glycogen synthesis and storage as it usually converts glucose to energy for cell’s use (Jensen & et al. 2011). When insulin is produced under insulin resistance, the cells are incapable of using them effectively which then leads to high blood sugar level as ketones and ketoacids are produced as an alternative energy source for the body. The rise of ketoacid causes the blood pH acidic and the patient may also be diagnosed with ketoacidosis (Newton & Raskin 2004). There would also be less intake of lipid and more of stored triglycerides as the lipids are effected by the insulin. As the glucose levels increase, the muscle glucose uptake will decrease while the liver glucose production and blood fatty acid concentration will also increase within the body (Lichtenstein & Schwab 2000). Excess glucose within the blood are converted to fat which can lead to Diabetic Dyslipidaemia and furthermore to obesity, hypertension and

“Diabetes is a silent killer” (Demille 2005, p.5). It is a metabolic disorder that can result in impaired quality of life and serious complications. This study aims to understand the case of Mr. Skyler Hanson who is newly diagnosed with Diabetes Mellitus Type 1 that leads to diabetic ketoacidosis which was confirmed by the presence of moderate to high ketones in the urine and a high blood glucose level. It was noted that he has a history of fatigue, headache, abdominal pain, nausea and frequent urination. Furthermore, it was disclosed that he has difficulty in adjusting to his diagnosis and he occasionally missed administration of insulin dose when socialising. Subsequently, he was admitted in the Critical Care Unit for rehydration,

Fluid and electrolyte management in Diabetic Ketoacidosis and Hyperosmolar Hyperglycaemic state in the emergency department

DKA is presented with three major physiological disturbances which are hyperosmolality due to hyperglycemia, metabolic acidosis because of the buildup of ketoacids, and hypovalemia from osmotic diuresis. Diabetic ketoacidosis is caused by a profound deficiency of insulin, its most likely occur in people with type 1 diabetes, inadequate insulin dosage, poor self management, undiagnosed type 1 diabetes, illnesses and infections. In type 1

Diabetes occur when there is a combination of inadequate secretion of insulin by the pancreatic beta cells and the peripheral insulin resistance. Insulin resistance leads to a reduced glucose transport into the muscle cells, increases both hepatic glucose production and breaking down of fats because it has been attributed to the elevated level of free fatty acids and proinflamatory cytokines in the plasma.1

J. J. is a 12-year-old, independent, type 1 diabetic; diagnosed at 5-years-old. Her experience of being diagnosed was a difficult and almost fatal one. It all started when J. J. got a bad ear infection and had an accident, which was extremely abnormal for her. The doctor put her on amoxicillin, and a week later she came down with a rash. J. J.’s mother brought her the doctor, and he thought it was mono. They did a mono test and the results came back negative, however, the doctor was sure it was mono. He told J. J.’s mother to stop giving her the amoxicillin and that the symptoms would subside. They stopped taking the antibiotic, however, J. J. symptoms got worse. She was frequently thirsty, using the restroom often, sleeping a lot, and would complain of stomach pain. J. J.’s mother said, “my ex and I would ask if the doctors were going to test her blood. None of the doctors did” (personal communication, October 26th, 2016). J. J. went to 4 different doctors before she was in some much pain that she couldn’t move and was throwing up; later that day, she was diagnosed in the Ellensburg’s Emergency Room. J. J.’s mother stated, “the ER doctor walk into the room and immediately said she diabetes, and needs to go to children’s now. The doctor said she could smell the ketones on J. J.’s breath.” (personal communication, October 26th 2016). Ketones are substances that the body creates, when it breaks down fat, instead of carbohydrates for energy. Ketones make the blood

Classic symptoms of diabetes usually presented with newly diagnosed diabetics are: hyperglycaemia, polyuria, polydipsia, polyphagia, fatigue, blurred vision, headaches, and unexplained weight loss. Ketone bodies are found in the urine, this abnormal finding occurs when fatty acid by-products (acetones) are excreted in the urine. The ketones are present from a lack of the insulin hormone used to metabolize fats and carbohydrates. Diabetic ketoacidosis (DKA) is a life-threatening complication which results from minimal useful insulin hormone in the body, hypoglycaemia, or insufficient food intake (American Diabetes Association, 2008).

Acute pancreatitis is an acute inflammatory process ranging from mild abdominal discomfort to severe disease involving multiple organ systems. Diagnosis is based on the presence of at least two of the following three features: abdominal pain; increased pancreatic amylase, and/or lipase levels to ≥3 times the upper limit of normal; and imaging tests showing characteristic findings of acute pancreatitis. The incidence of acute pancreatitis is known to differ geographically due to differences in alcohol consumption or in the incidence of gallstones disease in different parts of the world. Cholelithiasis is the leading cause of acute pancreatitis

Diabetic Ketoacidosis (DKA) is a disease state, most often seen in individuals with Type I Diabetes. While it most often results from uncontrolled insulin levels, young children can often present in diabetic ketoacidosis as the initial presentation of undiagnosed type I Diabetes. The major symptoms of Type I Diabetes, polydipsia, polyphagia, and polyuria, are often subtle and can be normal in growing children (Urden, Stacy & Lough, 2014; Wilson, 2012). Unless alert to the symptoms of Diabetes they can often be overlooked until severe enough to warrant immediate medical attention.

No diabetes ketoacidosis (DKA), blood sugar level (BSL) 8.6 mmols was within acceptable limit. DKA is a contributing factor to nausea and vomiting in diabetic patient with acute myocardial infarction (MI).

But in uncontrolled diabetic patients, blood glucose level increases leads to increase blood activity (ketoacidosis) and severe dehydration. If not treated, it could be dangerous for health or causing death. 16

As medical clinicians we are required to diagnose and treat patients for various conditions. Along with this diagnosis it is important to understand the pathophysiology of the condition and justify why this particular treatment/s was given. In this patient the signs and symptoms that were presented lead to the diagnosis and treatment of diabetic ketoacidosis (DKA).

Acute pancreatitis is a rapid inflammatory process when the tissue of pancreas “digests” itself due to enzymatic activity. The main reason for that is alcohol abuse and gallstones (Pfrimmer, 2008). Upon physical assessment of this patient, my findings were severe

The most common symptoms of diabetes mellitus are chronic elevated blood glucose level. Glycosuria is a condition in which the kidneys excrete increased glucose as they are unable to reabsorb the excess amount. This leads to fluid and electrolyte excretion which leads to electrolyte imbalance and dehydration. Loss of glucose leads to increase in the use of fats and protein for the energy, which leads to accumulation of ketone bodies in the blood which leads to ketoacidosis (could be fatal).

One of the most common causes of weight loss is diabetes, this can range from a couple of pounds to two-three stone. Weight loss is usually due to the increased metabolism and breakdown of muscle and fat due to insulin deficiency. Fluid depletion can also cause weight loss from both Polydipsia and Polyuria. When an individual presents with these features it is important for them to be picked up quickly otherwise Ketoacidosis can occur which may be fatal. Ketones are made up of acetone and two organic acids- beta-hydroxybutyric acid and acetoacetic acid. The liver and other cells can only process limited amounts of fatty acids, lipids and ketones at any given time, any excess of keytones is then secreted into the blood causing ketoacidosis. The binding of ketoacids and bicarbonate buffers within the blood, leading to an eventual decrease of PH in the blood due to decreased levels of serum bicarbonate (Gould and Dyer, 2011: 551). As dehydration occurs within the kidneys the demand on glomerular filtration decreases and so to does the excretion of acids leading to decompensated metabolic acidosis. Diabetic ketoacidosis or hyperosmolar coma are mostly due to the hyperosmolarity of the blood, secondary to hyperglycemia and the result of this can be fatal if not treated within a short period of time Less obvious presentation includes tiredness and weakness which is very common in uncontrolled diabetes. Alongside these presenting features comes visual blurring and fungal