Diabetic Ketoacidosis

Posted by e-Medical PPT Sunday, June 27, 2010
Diabetic ketoacidosis (DKA) is a state of absolute or relative insulin deficiency aggravated by ensuing hyperglycemia, dehydration, and acidosis-producing derangements in intermediary metabolism.Diabetic ketoacidosis is typically characterized by hyperglycemia over 300 mg/dL, low bicarbonate level , and acidosis with ketonemia and ketonuria.
With insulin deficiency, the tissues such as muscle, adipose tissues, and liver do not take up glucose. Counterregulatory hormones, such as glucagon, growth hormone, and catecholamines, enhance triglyceride breakdown into free fatty acids and gluconeogenesis, which is the main cause for the elevation in serum glucose level in diabetic ketoacidosis. Beta-oxidation of these free fatty acids leads to increased formation of ketone bodies. Overall, metabolism in diabetic ketoacidosis shifts from the normal fed state characterized by carbohydrate metabolism to a fasting state characterized by fat metabolism.Patient will have metabolic acidosis as the ketone bodies produced by beta-oxidation of free fatty acids deplete extracellular and cellular acid buffers. The hyperglycemia-induced osmotic diuresis depletes sodium, potassium, phosphates, and water as well as ketones and glucose.
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