Diabetic ketoacidosis

ketoacidosisacidosisDKAacute diabetesdiabetesdiabetes mellitus with ketoacidosisdiabetic ketosis
Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes mellitus.wikipedia
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Diabetes mellitus

diabetesdiabeticdiabetics
Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes mellitus.
Acute complications can include diabetic ketoacidosis, hyperosmolar hyperglycemic state, or death.

Diabetes mellitus type 1

type 1 diabetesjuvenile diabetestype 1
DKA happens most often in those with type 1 diabetes, but can also occur in those with other types of diabetes under certain circumstances.
Complications of relatively rapid onset include diabetic ketoacidosis and nonketotic hyperosmolar coma.

Acidosis

acidemiaacidaemiablood acidosis
DKA is typically diagnosed when testing finds high blood sugar, low blood pH, and ketoacids in either the blood or urine.
Another example of increased production of acids occurs in starvation and diabetic ketoacidosis.

Gliflozin

gliflozins
Drugs in the gliflozin class (SGLT2 inhibitors), which are generally used for type 2 diabetes, have been associated with cases of diabetic ketoacidosis where the blood sugars are not significantly elevated ("euglycemic DKA").
In May 2015 FDA issued a warning that gliflozins can increase risk of diabetic ketoacidosis (DKA).

Kussmaul breathing

deep gasping breathingKussmaul respirationsKussmaul's respirations
Signs and symptoms may include vomiting, abdominal pain, deep gasping breathing, increased urination, weakness, confusion, and occasionally loss of consciousness.
Kussmaul breathing is a deep and labored breathing pattern often associated with severe metabolic acidosis, particularly diabetic ketoacidosis (DKA) but also kidney failure.

Physical examination

physical exammedical examinationexamination
On physical examination there is usually clinical evidence of dehydration, such as a dry mouth and decreased skin turgor.
The healthcare provider uses the senses of sight, hearing, touch, and sometimes smell (e.g., in infection, uremia, diabetic ketoacidosis).

Nausea

nauseousvomitingfeeling of sickness
Predominant symptoms are nausea and vomiting, pronounced thirst, excessive urine production and abdominal pain that may be severe.
These include: pancreatitis, small bowel obstruction, appendicitis, cholecystitis, hepatitis, Addisonian crisis, diabetic ketoacidosis, increased intracranial pressure, Spontaneous Intracranial Hypotension, brain tumors, meningitis, heart attack, carbon monoxide poisoning and many others.

Hypokalemia

hypokalaemialow blood potassiumhypokalemic
Usually potassium is also needed to prevent the development of low blood potassium.
A special case of potassium loss occurs with diabetic ketoacidosis. Hypokalemia is observed with low total body potassium and a low intracellular concentration of potassium. In addition to urinary losses from polyuria and volume contraction, also an obligate loss of potassium from kidney tubules occurs as a cationic partner to the negatively charged ketone, β-hydroxybutyrate.

Tachypnea

rapid breathingtachypnoeaincreased rate of breathing
If Kussmaul respiration is present, this is reflected in an increased respiratory rate.
Amongst pathophysiological causes, tachypnea can be a symptom of sepsis, compensation for diabetic ketoacidosis or other metabolic acidosis, pneumonia, pleural effusion, carbon monoxide poisoning, pulmonary embolism, asthma, COPD, laryngospasm, allergic reaction causing airway edema, foreign body aspiration, tracheobronchomalacia, congestive heart failure, anxiety states, or many other medical issues.

Abdominal pain

stomach acheupset stomachstomachache
Signs and symptoms may include vomiting, abdominal pain, deep gasping breathing, increased urination, weakness, confusion, and occasionally loss of consciousness. Predominant symptoms are nausea and vomiting, pronounced thirst, excessive urine production and abdominal pain that may be severe.
uremia, diabetic ketoacidosis, porphyria, C1-esterase inhibitor deficiency, adrenal insufficiency, lead poisoning, black widow spider bite, narcotic withdrawal

Hyperglycemia

high blood sugarhyperglycaemiahyperglycemic
DKA is typically diagnosed when testing finds high blood sugar, low blood pH, and ketoacids in either the blood or urine.
Signs and symptoms of diabetic ketoacidosis may include:

Saline (medicine)

salinesaline solutionnormal saline
If dehydration is so severe as to cause shock (severely decreased blood pressure with insufficient blood supply to the body's organs), or a depressed level of consciousness, rapid infusion of saline (1 liter for adults, 10 ml/kg in repeated doses for children) is recommended to restore circulating volume.
By injection into a vein it is used to treat dehydration such as from gastroenteritis and diabetic ketoacidosis.

Ketoacidosis

alcoholicKetoacidotic
Ketoacidosis is not always the result of diabetes.
Three common causes of ketoacidosis are alcohol, starvation, and diabetes, resulting in alcoholic ketoacidosis, starvation ketoacidosis, and diabetic ketoacidosis respectively.

Maturity onset diabetes of the young

monogenic diabetesMaturity-onset diabetes of the youngMODY3
It was initially thought to be a form of maturity onset diabetes of the young, and went through several other descriptive names (such as "idiopathic type 1 diabetes", "Flatbush diabetes", "atypical diabetes" and "type 1.5 diabetes") before the current terminology of "ketosis-prone type 2 diabetes" was adopted.
MODY was originally applied to any child or young adult who had persistent, asymptomatic hyperglycemia without progression to diabetic ketosis or ketoacidosis.

Beta-Hydroxybutyric acid

β-hydroxybutyratebeta-hydroxybutyrate3-hydroxybutanoic acid
The absence of insulin also leads to the release of free fatty acids from adipose tissue (lipolysis), which are converted through a process called beta oxidation, again in the liver, into ketone bodies (acetoacetate and β-hydroxybutyrate).
Diabetic patients can have their ketone levels tested via urine or blood to indicate diabetic ketoacidosis.

Shock (circulatory)

shockcirculatory shockhemorrhagic shock
If dehydration is so severe as to cause shock (severely decreased blood pressure with insufficient blood supply to the body's organs), or a depressed level of consciousness, rapid infusion of saline (1 liter for adults, 10 ml/kg in repeated doses for children) is recommended to restore circulating volume.
Other causes include burns, environmental exposure, and excess urine loss due to diabetic ketoacidosis and diabetes insipidus.

Gastroenteritis

stomach flucholera morbusinfectious diarrhea
There is often a particular underlying problem that has led to the DKA episode; this may be intercurrent illness (pneumonia, influenza, gastroenteritis, a urinary tract infection), pregnancy, inadequate insulin administration (e.g. defective insulin pen device), myocardial infarction (heart attack), stroke or the use of cocaine.
Classical diabetic ketoacidosis (DKA) presents with abdominal pain, nausea, and vomiting, but without diarrhea.

Ketone bodies

ketone bodyketonesnegatively charged ketone
DKA results from a shortage of insulin; in response the body switches to burning fatty acids which produces acidic ketone bodies.

Adolph Kussmaul

Kussmaul
In his description, which he gave in an 1886 lecture at the Royal College of Physicians in London, he drew on reports by Adolph Kussmaul as well as describing the main ketones, acetoacetate and β-hydroxybutyrate, and their chemical determination.
Kussmaul breathing - Very deep and labored breathing with normal, rapid or reduced frequency seen in severe Diabetic ketoacidosis (DKA).

Julius Dreschfeld

The first full description of diabetic ketoacidosis is attributed to Julius Dreschfeld, a German pathologist working in Manchester, United Kingdom.
This is recognised as the first exposition of diabetic ketoacidosis.

Hyperosmolar hyperglycemic state

nonketotic hyperosmolar comahyperosmolar hyperglycemic statesHyperglycemic hyperosmolar state
Hyperosmolar hyperglycemic state (HHS, sometimes labeled "hyperosmolar non-ketotic state" or HONK) is much more common in type 2 diabetes and features increased plasma osmolarity (above 320 mosm/kg) due to profound dehydration and concentration of the blood; mild acidosis and ketonemia may occur in this state, but not to the extent observed in DKA.
The major differential diagnosis is diabetic ketoacidosis (DKA).

Insulin (medication)

insulininsulin therapyhuman insulin
This includes in diabetes mellitus type 1, diabetes mellitus type 2, gestational diabetes, and complications of diabetes such as diabetic ketoacidosis and hyperosmolar hyperglycemic states.