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

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).

Diabetic ketoacidosis (DKA) is an acute life threatening complication of diabetes. Although DKA is most common in patients with type 1 diabetes, it can also occur in those with type 2 as seen in our patient from the case study. DKA develops when there is an absolute or relative deficiency of insulin and an increase in the levels of insulin counter regulation (Huether & McCane, 2104). DKA is characterized hyperglycemia, ketoacidosis, and ketonuria.

Diabetic ketoacidosis (DKA) DKA and hyperosmolar hyperglycemic syndrome (HHS) occurs in 20 % of the elderly who have not previously been diagnosed with diabetes. HHS is more often found in the elderly, being precipitated by an acute illness or drug therapy (Childs, Cypress, & Spollett, 2009). DKA and HHS, are both similar in the aspect for a decrease in the effective concentration of insulin in conjunction with the counter regulatory hormones glucagon, cortisol, growth hormone and epinephrine. However, DKA and HHS differed in the driving force, degree of insulin deficiency, serum glucose levels, pH, serum osmolality and duration of symptoms (Childs, Cypress, & Spollett, 2009).

As we discuss acid and bases along with pH balance in blood a term that came to mind was Diabetic Ketoacidosis (DKA). This is a term that I have heard numerous times but didn’t not understand the meaning or cause. The term is commonly associated with diabetes but can also be associated with extreme exercise, low carbohydrate diets and eating disorders

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.

This paper will explore the history and hospital course of Mr. Z., a 23 year old Caucasian male who was admitted on October 11, 2016 to Massachusetts General Hospital for treatment of diabetic ketoacidosis (DKA) and new onset type 1 diabetes mellitus. DKA is an emergency situation that results in 100,000 hospitalizations in the US yearly, a 9% mortality rate, and treatments of reportedly 1 billion dollars per year (Katsilambros, Kanaka-Gantenbein, Liatis, Makrilakis, & Tentolouris, 2011). Presenting to the emergency room with DKA is the first manifestation of type 1 diabetes in 30% of cases (Katsilambros et al., 2011). This paper will examine Mr. Z.’s case presentation, pertinent medical history, diagnosis formulation, hospital management, intensive review of his medications, and discussion.

In Ketoacidosis the body is making too many ketones due to fats being burned for absent carbohydrates as source of energy, excessive amount of fats in the body become acidic creating the ketones. Possible cause are diabetics not receiving proper insulin and hydration, excessive alcohol drinking with low po intake, as well as anoxia. The patient have the following signs and symptoms tachypnea, tachycardia, HA, confusion, tired or weakness, loss in appetite, and or N/V. Treatment is to correct the imbalance or the underlying cause of the imbalance ie hydration fluids, Insulin

Diabetic ketoacidosis is a complication that occurs in diabetic patients in the result of low insulin levels in the body. When the body does not have enough insulin in the body it begins to break down fats for energy which produces ketones. The existence of DKA in type 2 diabetics is frequently related to conditions of extreme stress. (Lin, Bishop, & Benito-Herrero, 2010). In this patient an acute infection is the cause of ketoacidosis. During an infection your body produces higher levels of hormones that may counter the effect of insulin which in return leads to low levels of insulin causing lipolysis and creating ketones. Therefore, infections in diabetics can trigger ketoacidosis.

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

Approximately 85% to 90% of acute pancreatitis patients show a mild clinical progression that locally limited and responds well to conventional medication. Meanwhile, necrotizing pancreatitis, which ac¬counts for the residual of cases, have a serious clinical complications (Steer 1993, Hyun and Lee 2014). The final consequence of AP can be determined by the long-lasting of systemic inflammation and failure of remote organs. Moreover, obesity and high fat intake in daily diets cause several serious health problems (Yang et al. 1997, Diehl 2002).

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).