dka
DESCRIPTION
This presentation was present by my friend during emergency posting seminar with Dr.Mohd. Kamal Mohd. Arshad. I upload this ppt here for all of us and my own reference too. Good luck in your life.TRANSCRIPT
DIABETIC EMERGENCIES
NasruddinKamaruddin
RazziSiti SurayaSarah AliahShuhaidaRohaida
Nurfauzani
DIABETIC KETOACIDOSIS
ROHAIDA CHE MOHD ABDULLAHRAZZI HAJEMI
• Major medical emergency
• Serious cause morbidity
• In type 1 DM
• Usually due to (causes) :– Unknown or newly diagnosed cases of type 1
diabetes– Missed or inadequate doses of insulin, or
spoiled insulin– Intercurrent infection, lose their appetite, stop
or drstically reduced their dose of insulin– Stress, with increasing insulin resistance and
requirement eg: infection, trauma, surgery, myocardial infarction, and stroke.
LACK OF INSULIN1. DECREASED CATABOLISM (glucose)
Hyperglycemia - fatigue
Glycosuria – vulvitis
Osmotic diuresis – polyuria, polidipsia
Salt n water depletion – tachycardia, - hypotension
- dehydration
• Dehydration with decreased perfusion to the tissues leads to lactic acidosis, which contributes to more profound acidosis.
2. INCREASED ANABOLISM
Gluconeogenesis - wastingGlycogenolysis
Lipolysis - loss of weight
Hyperketonemia
Acidosis – hyperventilationPeripheral vasodilation –
hypotension, hypothermia
Diabetic Ketoacidosis
3. INCREASED SECRETION
GlucagonCostisol
CathecolamineGrowth hormone
ANTAGONIZED INSULIN
DEATH !!!
Clinical feature
• As above…• Vomiting• Blurred vision• Abdominal pain (children)• Confusion, drowsiness• Cold peripheries /peripheral cyanosis• Ketone breath (smell of acetone) • Coma (uncommon)
METABOLIC ACIDOSIS
pH - <7.3 / 7.25 () (N – 7.35-7.45)
HCO3 - ?
pH = log 6.1 + [HCO3-]
0.03pCO2
HCO3 - ()
WHY develop hyperventilation?
• The combination of ketoacid formation and dehydration results in metabolic acidosis, and, for compensatory alkalosis,
• rapid deep breathing (Kussmaul respirations) may be manifested at advanced stages
• Kussmaul breathing – to wash out the CO2. thus – patient develop hyperventilation
• The resulting metabolic acidosis – forces the hydrogen ions into cells, displacing potassium ions (whish may lost in urine or through vomiting)
•
H + H + K+
K+ H + H +
K+ H +
K+ H + K+
H + K+
K+
K+
Diagnostic Criteria
• Random Blood Sugar > 11.1 mmol/L
• Ketonemia > 90mg/dL , ketonuria >5000mg/24hr
• Aterial blood gases, pH<7.3/7.25
• HCO3 <15 mmol/L
INVESTIGATION
• Random blood glucose
• Arterial Blood Gases
• Full blood count
• Renal profile
• CXR
• ECG
• Urine FEME
COMPLICATION
• Cerebral Edema (hyponatremia)
• Aspiration pneumonia (coma)
• Hypokalemia
• Hypomagnesaemia
• Hypophosphatemia
• Thromboembolism
REFERENCES
• Oxford Handbook Clinical Medicine
• Davidson’s principle and practice of medicine
• Lippincott’s biochemistry
THANK YOU