DIABETIC KETOACIDOSIS. Diabetes Mellitus {sugar diabetes} An ancient disease Names in ancient times...
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Transcript of DIABETIC KETOACIDOSIS. Diabetes Mellitus {sugar diabetes} An ancient disease Names in ancient times...
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DIABETIC KETOACIDOSIS
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Diabetes Mellitus {sugar diabetes}
• An ancient disease
• Names in ancient times by Greek physicians
• The noted that those with diabetes produced large amounts of urine that attracted bees and other insects
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Diabetes {to siphon or pass through} Mellitus {honey sweet}
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Diabetes Mellitus• Inadequate insulin activity of the body• Due to inadequate production of insulin or
to decreased responsiveness of body cells to insulin
• Insulin is crucial to maintain normal blood glucose levels
• Insulin allows the body to store glycogen, protein and fat as sources of energy
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• Glucose is especially important for brain cells as this is the only substance the brain cells can utilize for energy
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• Insulin of course is a hormone
• Hormone
Chemical messenger
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Role of the kidneys• Blood is filtered through the gloumeruli• Glucose and water pass into the proximal
tubule• Water and glucose is reabsorbed• The amount of glucose reabsorbed is
dependent on glucose levels• Glucose lost in urine can result in
dehydration affecting osmosis
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Osmosis
• Water crosses the cell membrane to achieve equivalence on both sides
• Relative to the kidneys; tubules and surrounding capillaries
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When glucose spills into the urine:
• Concentration inside the tubule is higher than that of the capillaries
• Water follows glucose in urine causing a noted water loss
This is called osmotic diuresis
• Diuresis is the formation and secretion of urine
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Glycosuria
• Presence of glucose in urine
• Creates the sweet urine {Mellitus; honey sweet}
• With osomotic diuresis, there is also a loss of K+
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DIABETIC KETOACIDOSIS
• Complications of Type I diabetes
• Due to decreased insulin intake
• Marked by:
high blood glucose
metabolic acidosis
coma
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• Serious and potentially life-threatening
• Insulin deficiency plus increased glucagon activity
• Glucagon; hormone released by the pancreas to raise blood glucose levels
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Pathophysiology
Ketosis
• The body uses fat as opposed to glucose as its primary energy source
• Fatty acids in the blood significantly rise
• Most of the fatty acid is utilized
• Some is taken in by liver cells and catoblized
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Catabolism:
Breaking down phase of metabolism
• The catabolism of fatty acids in the liver produces aceoacetic acid
• When more is released that the body can use it accumulates in the blood along with…
• Acetone and B-hydorxybutyric acid
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• Acetone is naturally produced and disposed of in the human body as a result of normal metabolic processes.
• beta-hydroxybutyrate is synthesized in the liver from acetyl-coA and can be used as an energy source by the brain when blood glucose is low
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Acetoacedic acidAcetoneB-hydroxybutyric acid
collectively called ketone bodies
Significant quantities in the blood is called…
KETOSIS; hence……..
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DIABETIC KETOACIDOSIS
or
DIBETIC COMA
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• In the initial phase acute hyperglycemia
• Body cells cannot take in glucose
• Gluconeogenesis contributes more blood glucose
• Loss of glucose in urine + osmotic diuresis causes severe dehydration
• As the body Δs to fat-based metabolism, level of ketones rise
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Gluconeogenesis
The compensatory mechanism within the
cells to combat low glucose levels
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• The ketone load accounts for the acidosis
• When the pH decreases to about 6.9 the patient is hours from death
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SIGNS AND SYMPTOMS
• Onset is slow
12 to 24 hours
• Increased urinary output
• Dry, warm skin
• Hunger and thirst
• General malaise
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• Tachycardia | volume
• Weakness | depletion
• Kussmaul’s Respirations
Rapid, deep breathing in an attempt to expel
CO2
• Fruity odor on the breath
Some acetone is expelled through the lungs
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Cardiovascular System
Pulse
Blood pressure
Rapid
Low
Respiratory System
Rate
Breath Odor
Exaggerated air hunger
Acetone
Nervous System
Mental Status Restless to Unconscious
Gastrointestinal System
Mouth
Thirst
Vomiting
Abdominal Pain
Dry
Intense
Common
Frequent
Ocular System
Vision Dim
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Assessment of a patient with AMS or is
Unconscious