Insulin deficiency, increased insulin counterregulatory hormones cortisol, glucagon, growth hormone, and catecholamines and peripheral insulin resistance lead to hyperglycemia, dehydration, ketosis, and electrolyte imbalance which underlie the pathophysiology of dka. Apr 02, 2020 the pathophysiology of diabetic ketoacidosis includes all of the unhealthy chemical reactions that occur in the body because of hormone release and uncontrolled elevated blood sugar. Pathophysiology of diabetic ketoacidosis diabetic ketoacidosis is one of the potentially lifethreatening acute complications of diabetes mellitus. Dka is a severe metabolic derangement characterized by dehydration, loss of electrolytes, hyperglycemia, hyperketonemia, acidosis and progressive loss of consciousness that results from severe insulin deficiency combined with the effects of increased levels of counterregulatory hormones catecholamines, glucagon, cortisol, growth hormone. Pathophysiology of diabetic ketoacidosis nursing journal. And this leads to acids ketones being produced, which can lead to acidosis. In the usual clinical situation, a rise in counterregula. Pathophysiology of hypokalemia in dka diabetestalk. Dec 26, 2017 prevention of dka is the ultimate goal 80% of hospital admissions for dka occur in treated diabetics 3,8. What is the pathophysiology of diabetic ketoacidosis. We discuss the pathophysiology of diabetic ketoacidosis, its management, and its complications. Pathophysiology dka results from a dysregulation of. Dka and hyperosmolar state hhs are disease on the same spectrum, but their clinical presentation and pathophysiology, and thus, their treatment differ.
Dka is the first manifestation of type 1 dm in a minority of patients. Having an understanding of its pathophysiology, a consequence of absent to low insulin levels, delineates the clinical presentation. Nov 25, 2018 in this video we cover diabetic ketoacidosis. Diabetic ketoacidosis dka is an acute, major, lifethreatening complication of diabetes characterized by hyperglycemia, ketoacidosis, and ketonuria. Introduction diabetic ketoacidosis dka is an acute, major, lifethreatening complication of diabetes. Insulin normally plays a key role in helping sugar glucose a major source of energy for your muscles and other tissues enter your. Prevention of dka is the ultimate goal 80% of hospital admissions for dka occur in treated diabetics 3,8. Pathophysiology of diabetic ketoacidosis the patient experiencing dka presents significantly different from one who is hypoglycemic. Pathophysiology dka results from insulin deficiency from. Cerebral edema is the most frequent serious complication of diabetic ketoacidosis dka in children, occurring in 1% to 5% of dka episodes. Insulin is necessary to take sugar from the blood to the cells for energy. It is necessary for clinicians to understand the pathophysiology and treatment of dka to care for this increasing diabetic population.
May 31, 2019 diabetic ketoacidosis dka is an acute, major, lifethreatening complication of diabetes characterized by hyperglycemia, ketoacidosis, and ketonuria. Fluid depletion is a serious problem caused by osmotic diuresis. Diabetic ketoacidosis and hyperglycemic hyperosmolar state asped. The condition develops when your body cant produce enough insulin. The beta cells are attacked and can no longer produce and secrete insulin.
Combined with the insufficiency of insulin effect, there is an increase in counter regulatory hormone levels, including glucagon, cortsol. Pathophysiology the basic cause of dka and hhs is insufficient insulin effect. The condition may develop in individuals who have gestational, insulindependent type 1, or noninsulin dependent type 2 diabetes. Enhanced fat breakdown increases serum free fatty acids that are then metabolised producing large quantities of ketones and metabolic acidosis. Nurses need to know how to identify and manage it management of diabetic. The pathophysiology of diabetic ketoacidosis includes all of the unhealthy chemical reactions that occur in the body because of hormone release and uncontrolled elevated blood sugar. In the past, diabetic ketoacidosis was considered as the hallmark of type i diabetes, but current data show that it can be also diagnosed in patients with type ii diabetes mellitus. Hormonal alterations in dka lead to increased gluconeogenesis, hepatic and renal glucose production, and impaired glucose utilization in peripheral tissues, which result in. Diabetic ketoacidosis is a serious complication of diabetes that occurs when your body produces high levels of blood acids called ketones.
Diabetic ketoacidosis symptoms and causes mayo clinic. Introduction diabetic ketoacidosis dka is a potentially life threatening complication in people with diabetes mellitus. Pdf diabetes ketoacidosis find, read and cite all the research you need on researchgate. So lets get into the nitty gritty of the pathophysiolog of diabetic ketoacidosis. Oct 24, 2017 diabetic ketoacidosis one of the hyperglycemic crises, dka, pathophysiology, causes, clinical presentation signs and symptoms and treatment. Generally, the rates of dka are inversely proportional to rates of diabetes in that community, but throughout the u. The criteria for hyperglycemic hyperosmolar state hhs include. More commonly seen in patients with type 1 diabetes t1d, dka results when lipid breakdown generates a surplus of acidic.
It is characterised by absolute insulin deficiency and is the most common acute hyperglycaemic complication of type 1 diabetes mellitus. In this video, well break down dka pathophysiology, so that you can finally understand it for nursing school. In new onset diabetes, dka is frequently the consequence of a delay in diagnosis e. The condition may develop in individuals who have gestational, insulin dependent type 1, or noninsulin dependent type 2 diabetes. Diabetic ketoacidosis can occur in persons of all ages, with 14 percent of cases occurring in. It causes nausea, vomiting, and abdominal pain and can progress to. Acute complications of diabetes khan academy free online. Kristin print rn, bsn pccnp, msn student university of. Recurrent dka without a preceding febrile or vomiting illness is almost always the result of psychosocial problems and failure to take insulin e. Diabetic ketoacidosis dka is an acute metabolic complication of diabetes that is potentially fatal and requires prompt medical attention for successful treatment. When glucose falls dka is a severe metabolic derangement characterized by dehydration, loss of electrolytes, hyperglycemia, hyperketonemia, acidosis and progressive loss of consciousness that results from severe insulin deficiency combined with the effects of increased levels of counterregulatory hormones catecholamines, glucagon, cortisol, growth hormone. Diabetic ketoacidosis introduction diabetic ketoacidosis dka is a very serious complication of diabetes mellitus, a metabolic disorder that is characterized by hyperglycemia, metabolic acidosis, and increased body ketone concentrations. In several series, only about a fifth of patients with dka are firsttime presenters with recently acquired type i. Management of an episode of dka is not complete until an attempt has been made to identify and treat the cause.
Diabetic ketoacidosis, in a nutshell, happens when the body cant use glucose for energy, and so it breaks down fat instead. Diabetic ketoacidosis one of the hyperglycemic crises, dka, pathophysiology, causes, clinical presentation signs and symptoms and treatment. Dka is the most common cause of death in children with type 1 diabetes t1dm. Pathophysiology diabetic ketoacidosis dka is a complex disordered metabolic state characterised by hyperglycaemia, acidosis, and ketonaemia.
Hyperglycemia causes an osmotic diuresis with significant fluid and electrolyte loss. Diabetic ketoacidosis and hyperosmolar hyperglycemic. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome. A better understanding of the pathophysiology of dka and an aggressive, uniform approach to its diagnosis and management have reduced mortality to 5% of reported episodes in experienced centers. Diabetic ketoacidosis dka society of hospital medicine. Diabetic ketoacidosis is characterized by a serum glucose level greater than 250 mg per dl, a ph less than 7. Diabetic ketoacidosis dka, hyperglycemic hyperosmolar state. Pathophysiology of diabetic ketoacidosis 2018 nursing. Diabetic ketoacidosis dka is a frequent abnormal metabolic entity seen in highdependency units such as critical care units and in the emergency department. Diabetic ketoacidosis and hyperglycemic hyperosmolar state. This is due to the variation in the pathology of the condition. It occurs when absolute or relative insulin deficiency inhibits the ability of glucose to enter cells for utilization as metabolic fuel, the result being that the liver rapidly breaks down fat into ketones to employ as a fuel.
Diabetic ketoacidosis is a serious complication of diabetes mellitus type 1. Pathophysiology of diabetic ketoacidosis dka and of h. Prebreakfast administer both glargine and aspart dose according to premeal aspart order set. Lets discuss one of the acute complications of diabetes, known as diabetic ketoacidosis, or dka for short, which can occur in individuals with type 1 diabetes. Dka usually occurs as a consequence of absolute or relative insulin deficiency that is accompanied by an increase in counter. Dka without a preceding febrile illness or gastroenteritis in a patient with known diabetes is almost always the result of psychosocial problems and failure to appropriately administer insulin. It happens predominantly in those with type 1 diabetes, but it can occur in those with type 2 diabetes under certain circumstances. Diabetic ketoacidosis symptoms, diagnosis and treatment.
Learn the pathophysiology behind the disease process, and then use that knowledge to remember how to properly treat the condition. The problem in diabetes mellitus type 1 is the absolute lack of insulin. Diabetic ketoacidosis dka is most common among patients with type 1 diabetes mellitus and develops when insulin levels are insufficient to meet the bodys basic metabolic requirements. And all of these can be tricky to learn as a nursing student. Discussion of pathophysiology, identification, diagnosis, and treatment of dka and hhs learn with flashcards, games, and more for free. And dka mostly happens during type 1 diabetes, but it can also happen during type 2 as well. Now recall that type 1 diabetes is an autoimmune disorder. Diabetic ketoacidosis is an acute metabolic complication of diabetes characterized by hyperglycemia, hyperketonemia, and metabolic acidosis. Diabetic ketoacidosis in infants, children, and adolescents. Pathophysiology drives therapy choose the correct protocol. Poor patient education is probably the most important determinant of the incidence of the catastrophe that constitutes dka. Both diabetic ketoacidosis and hhs result from relative or.
Safety loc stress free path physiology the classic neuropathology findings in ad include amyloid plaques, neurofibrillary. Some of the major complications of dka are related to its treatment box 3. With progressive insulin deficiency, excessive glucose production and impairment of utilization result in hyperglycemia, with glycosuria developing when the renal threshold of 180 mgdl is exceeded. Once dka crisis resolved, counsel child and family on prevention strategies inform families and child of acute and chronic complications associated with dka give families information on support groups and resources for children with diabetes involve all necessary services including endocrinology, child life, and social work. Many cases could be prevented by better access to medical care, education and effective communication between patients and health professionals during concurrent illness kitabchi et al, 2004. And if you want to know more about diabetic ketoacidosis, you can click the button above to download a free dka study guide. Lipase activity increases, causing a breakdown of adipose tissue that yields free fatty acids.
Diabetic ketoacidosis dka pathophysiology, animation youtube. Dka is a state of severe insulin deficiency which causes. Dka is an acidosis from a deficiency or relative deficiency of insulin which leads to a metabolic acidosis. In this video, well break down dka pathophysiology, so that you can finally understand it. However, the acute complications of diabetes mellitus are often the most serious, and can be potentially even life threatening. The most common causes of dka are infection and poor compliance with medication regimens. Pathophysiology of diabetic ketoacidosis diabetes library. Diabetic ketoacidosis dka, hyperglycemic hyperosmolar. Without insulin delivery sugar to the cells, hyperglycemia high blood sugar occurs.
Enhanced lipolysis increases serum free fatty acids. In the usual clinical situation, a rise in counterregulatory hormones contributes to accelerated gluconeogen esis, glycogenolysis, and impaired glucose utilization by peripheral tissues and leads to diabetic ketoacidosis. Type 1 occurs when there is an autoimmune the body attacks the pancreas response. Epidemiology and pathophysiology of diabetic ketoacidosis guidance on diagnosis, management and complications the nurses role in caring for patients with dka diabetic ketoacidosis is a potentially lifethreatening complication of diabetes, making it a medical emergency. Dec 26, 2017 a better understanding of the pathophysiology of dka and an aggressive, uniform approach to its diagnosis and management have reduced mortality to 5% of reported episodes in experienced centers. In order to understand the pathophysiology of diabetic ketoacidosis, youll need to understand the pathophysiology of diabetes as well. In several series, only about a fifth of patients with dka are firsttime presenters with recently acquired type i diabetes mellitus. Without insulin, glucose will not be transported to the cells. Dka usually occurs as a consequence of insulin deficiency.
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