DIABETIC

KETOACIDOSIS(DKA)
PRESENTED BY: S.MATHANAGOPALAN.

INTRODUCTION
DKA is the combination of dehydration and acidosis. It is characterized as the biochemical triad involving: - Hyperglycaemia(blood glucose higher than 250 mg/dl) - Excessive ketoacids in blood and urine. - Metabolic acidosis-PH below 7.3. It occurs in people with type1 diabetes either at onset, or in people with established diabetes. DKA in people with pre-existing type2 diabetes often

CAUSES OF DKA
Insulin

omission ssssor poor adherence to the insulin regimen. (Its may be due to poor finance , inability to acquire insulin or improper understanding of the critical need for insulin) Alcohol abuse Trauma Pulmonary Embolism Myocardial Infraction

MECHANISM OF INSULIN DEFICIENCY

INSULIN DEFICIENCY.doc
Reduced

glucose uptake leads to hyperglycaemia. Hyperglycaemia leads to increased osmotic diuresis. Shift of water and potassium from the cells into the extracellular space leads to ketonuria. The loss of potassium leads to decreased glomerular filtration rate and retention of glucose and ketoanions.

KETONES
Normal blood ketone level is < 0.5mmol/l. TYPES OF KETONES: Acetone(Excreted from lung and present in urine) Acetoacetate (Excreted in the urine) Beta-hydroxybutane(Present in the blood not in urine)

SIGNS AND SYMPTOMS OF DKA

Early symptoms of DKA are the same as hyperglycaemia like increased thirst and frequent urination. Nausea and vomitting. Abdominal pain. Leg cramps. Acid smelling breath. Kussmauls breathing.

DIAGNOSIS
KETONES: Blood>3mmol/l Urine moderate to large MILD:PH 7.25 & 7.30 Serum bicarbonate: 15 to 18mmol/l. MODERATE:PH 7.00 to 7.25 Serum bicarbonate:10 to 15mmol/l. SEVERE:PH<7.00 Serum bicarbonate: less than10mmol/l.

DIAGNOSIS Contd.
High

blood glucose level and ureal creatinine, dehydration. Cardiac monitoring This is very important in severe DKA to access the possibility of heart attack.

GOALS
Improving

the circulating volume and tissue

perfusion. Decreasing serum glucose and osmolaring. Cleaning blood and urine ketones. Correcting the electrolyte imbalances.

TREATMENT
INSULIN: The recommened insulin infusion dose is 0.1 unit/kg/hour. FLUID: Fluid replenishment is essential in the initial treatment of DKA to reverse the hydration. Blood glucose levels are lowered by improving the Renal perfusion. Shock and severe dehydration must be corrected with normal saline. Dextrose should be added to the replacement fluids when the blood glucose falls below 250 mg/dl.

TREATMENT Contd
POTASSIUM: It s replacement should not be starred until the serum plasma concentration is less than 5.5 mEq/l. Unless the person present with hypokalaemia. Electrocardiogram monitoring should be done during the potassium replacement.

BLOOD GLUCOSE MONITORING

If

the blood glucose level have not to be dropped by 45 to 54 mg/dl in the first hour. Rapid fall in blood glucose is increased , It is the risk of cerebral oedema. Monitoring the overload , headaches and changes in cerebral function is important.

DKA RECOVERY
Treatment

may result in rapid improvement particularly in children. Once conciousness is reestablished with the people,it should be starred on the oral fluids and food. It is safe to start subcutaneous. Short(or) rapid acting Insulin. Soluble Insulin must be given 30 to 60 minutes before stopping the IV insulin infusion. Potassium containing drinks and foods may be helpful to complete the procells ofs replacing the entire deficit.

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