Diabetic Ketoacidosis Research Paper

Shannon’s glucose levels are still high (above 6.1 mmol/L) thus still needs the insulin drip (Robbins et al., 2010). Administration of insulin and efforts made to correct metabolic acidosis forces potassium into the cells causing hypokalemia (Bopp, 2010). Thus, even though the potassium is within therapeutic levels (3.5-5 mmol/L) there is a high chance that Shannon may experience hypokalemia and the administration of NS with potassium is necessary (Bopp, 2010).

Ketosis is the metabolic state that most of the body's energy supply comes from ketone bodies in the blood, contrasting to the state of glycolysis in which blood glucose provides most of the energy (Taubes, 2011, 140-141). Ketosis might be better known as acetone breath, a common symptom of progressing diabetes mellitus type. It is characterized by serum concentrations of ketone bodies, with low and stable levels of insulin and blood glucose. It is commonly generalized with hyper-ketonemia, which is an elevated level of ketone bodies in the blood throughout the body. Ketone bodies are formed by ketogenesis as the liver glycogen stores are depleted (Taubes, 2011, p.155). The ketone bodies used for energy are acetoacetate and beta-hydroxybutyrate, with that, the levels of ketone bodies are regulated mainly by glucagon and insulin (p.156). Most cells can then be used by both glucose and ketone bodies for fuel, and during ketosis, free fatty acids and glucose synthesis fuel the rest.

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,

Diabetes Mellitus is a growing issue for health care providers internationally. The World Health organization estimated in 2013 there were 347 Million diabetics worldwide, predicting that Diabetes will be the 7th leading cause of death by 2030 (WHO, 2013). In both type 1 and type 2 diabetes Mellitus, factors such as poor compliance with diet and medication, infection, acute medical or surgical illness or trauma can lead to poor glycaemic control, precipitating a hyperglycaemic emergency such as Diabetic Ketoacidosis (DKA) (Scobie & Samaras, 2009). In Type 2 Diabetes, another equally dangerous

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

My interest in this topic is a result of recent experiences with Diabetes Mellitus, Type 1 (DMI), especially with the following two instances: a young adult patient admitted at the hospital following a DKA episode during one of my nursing rotations and one of my instructors with type 1 diabetes. Also, my father was diagnosed with type 2 diabetes, this has increased my eagerness to study and explore more about the disease.

Complication of Type 1 Diabetes Mellitus (T1DM) can develop gradually over the decades and may be disabling or even-life-threatening. T1DM can affect multi-organ system including the heart, blood vessels, nerves, eyes and kidneys. Due to poor blood sugar level control and multiple episodes of hospital admission due to hyperglycemia and DKA, KK might be at risk of developing these sorts of complications. Thus a good blood sugar management and early intervention is necessary in order to prevent or delayed this kind of complications from happening in the future.

Diabetic ketoacidosis is an event which occurs when there is not enough insulin in the body to utilize sufficient amount of glucose needed to provide cells with energy; body then starts to use fatty acids as a fuel, which are converted to ketones in the liver. In healthy people who do not have diabetes, ketone bodies are produced in normal quantities and then successfully used by tissues as energy supply. This state is known as dietary ketosis and it is completely normal and may even provide health benefits. But in those who have diabetes, ketones are produced in enormous quantities and aren't used in full by cells, so they start to build up in the blood. Acids 3-hydroxybutyric acid and acetoacetic acid are produced rapidly causing decrease in buffering capacity of the blood and eventually depleting buffering systems (Manninen, 2004).

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).

Patients with DKA are usually severely dehydrated. This is a result from polyuria and osmotic diuresis. Osmotic diuresis occurs when the concentration of glucose is higher than the reabsorption capacity of the kidney, so glucose remains in the filtrate. This increases the osmotic pressure which causes an increase in water and potassium to be excreted out into the

Diabetic Ketoacidosis is a condition of Insulin deficiency and hyperglycaemia resulting in metabolic acidosis and severe osmotic diuresis.

Patient G.M. is a four-year-old female from a middle class family living in San Diego. She originally presented with her mother and father to her general practitioner with lethargy and several vomiting episodes in the past few days. Her father stated concern after realizing her frequent urination in the past week. Her vital signs upon initial assessment were HR 140 RR 22 Temperature 102.7 degrees Fahrenheit, BP 70/62, O2 saturation 97%, 32 pounds, and 40 inches tall. Her General practitioner was concerned about type I diabetes and performed a blood sugar check. Upon assessment the monitor read HI, indicating that the level was above 500 and too high for the monitor to read. The doctor informed them she needed immediate treated in the closest pediatric ER due to the potential for diabetic ketoacidosis.

Diabetic Ketoacidosis (DKA) is an acute complication of uncontrolled glucose levels characterized by reduced levels of insulin and presence of ketones. It is a medical emergency and results can be detrimental if left untreated. DKA is commonly seen in patients with type 1 diabetes mellitus (type 1 DM). However, critically ill patients with type 2 diabetes mellitus (type 2 DM) such as trauma, surgery or infection, are also at risk for DKA (Ignatavicius & Workman, 2013). Patients with type 1 DM are predisposed to DKA if their underlying conditions are not diagnosed early and in some cases, they may experience similar signs and symptoms without actually developing DKA. Comorbidities involving parts of

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).