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. The problem in diabetes mellitus type 1 is the absolute lack of insulin. Management of dka has changed in the last decade, and national guidelines introduced, to help standardise care, spread best practice, and reduce mortality and morbidity. We discuss the pathophysiology of diabetic ketoacidosis, its management, and. The exact prevalence is unknown, but in one community the rate was estimated to be. In the last decade, however, there has been a change in the way patients with dka present clinically and in addition there has been rapid development of nearpatient testing.
Pathophysiology of biochemical derangements in dka. It can also occur in patients with other types of diabetes. Whatyoushouldknow diabeticketoacidosis dkaisacommon,serious,andpreventablecomplicationoftype1diabetes,withamortalityof3. Diabetic ketoacidosis dka is a common, serious, and preventable complication of type 1 diabetes, with a mortality of 35%. It can be lifethreatening, but it usually takes many hours to become that. This article outlines updates in the clinical management of. Diabetic ketoacidosis dka is the most serious hyperglycaemic emergency in patients with type 1 and type 2 diabetes mellitus dm and is associated with significant morbidity and mortality. 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. Diabetic ketoacidosis dka and hyperosmolar hyperglycemic state hhs, also known as hyperosmotic hyperglycemic nonketotic state hhnk are two of the most serious acute complications of diabetes. Diabetic ketoacidosis dka is a common and potentially lifethreatening complication of diabetes mellitus, the second most common chronic childhood disease 1. Diabetic ketoacidosis is a common problem in type 1 diabetics and can be the presenting feature of newlydiagnosed diabetes. Dec 22, 2012 diabetic ketoacidosis dka remains a significant complication of diabetes in both the united states and around the world. More commonly seen in patients with type 1 diabetes t1d, dka results when lipid breakdown generates a surplus of acidic.
Unfortunately, errors in its management are not uncommon and importantly. Pathophysiology of diabetic ketoacidosis diabetes library. Pdf management of diabetic ketoacidosis researchgate. She is a working educator, currently serving as a diabetes program. Diabetic ketoacidosis is an unusual consequence of this most severe form of transient diabetes mellitus. This acidbase and electrolyte teaching case discusses dka management, emphasizing complications of treatment. Diabetic ketoacidosis usually happens because your body doesnt have enough insulin.
Glucagon activates the carnitine acyl transferase i leading to ketonemia. It causes nausea, vomiting, and abdominal pain and can progress to. Diabetic ketoacidosis dka is a frequent abnormal metabolic entity seen in highdependency units such as critical care units and in the emergency department. Diabetics usually learn to recognize the causes and the symptoms of. The typical patient with diabetic ketoacidosis is an adolescent or a child who is ill and who is presenting to the emergency department. Diabetic ketoacidosis remains a significant complication of diabetes in both the united states and worldwide with its associated high rates of hospital admissions. Jan 09, 20 unsubscribe from medcram medical lectures explained clearly. It is commonly precipitated by poor adherence to medication, stress and concurrent illness.
Directions to hospitals treating diabetic ketoacidosis. They suggest that lack of adherence to insulin treatment was the major factor contributing to longterm poor glycaemic control and to diabetic ketoacidosis dka in these young patients. Diabetic ketoacidosis pathophysiology 2018 youtube. Evidence implicating excess stress hormone secretion as a necessary event in the development of severe metabolic decompensation is. Pathophysiology of type 1 and type 2 diabetes mellitus. Diabetic ketoacidosis dka explained clearly diabetes. Although mortality is currently pathophysiology, diagnosis and management of diabetes mellitus habtamu wondifraw baynest university of gondar, ethopia corresponding author. Use the link below to share a fulltext version of this article with your friends and colleagues. A concerning number of people also develop dka while already in hospital. Treatment diabetic ketoacidosis is an emergency and requires urgent medical attention, often in and intensive care setting. A 39yearold nigerian woman presented with significant weight loss, severe diabetic ketoacidosis, and severe insulin resistance requiring massive doses of exogenous insulin.
Management and has been published in the american journal of nursing, nurseweek, progress for cardiovascular nursing, stanford nurse and the japanese journal of nursing. Beverly is a nationally recognized speaker and consultant, dedicated to improving diabetes care. Hyperchloremic acidosis during the recovery phase of diabetic ketosis. Kitabchi division of endocrinology, diabetes and metabolism, university of tennessee health science center, 920 madison ave. Having an understanding of its pathophysiology, a consequence of absent to low insulin levels, delineates the clinical presentation. And all of these can be tricky to learn as a nursing student. Diabetic ketoacidosis is a buildup of acids in your blood. Diabetic ketoacidosis australia pdf ppt case reports. Diabetic ketoacidosis without diabetes the journal of. Your cells cant use the sugar in your blood for energy, so they use fat for fuel instead. In order to understand the pathophysiology of diabetic ketoacidosis, youll need to understand the pathophysiology of diabetes as well. Recent studies indicate that for the development of diabetic ketoacidosis glucagon excess is essential in addition to a deficiency of insulin. Consequently, a person feels hungry despite of eating adequately and the level of glucose in the body is increasing because cell. Pathophysiology of diabetic ketoacidosis nursing journal.
Low dose continuous infusion of insulin appears to be the ideal mode of therapy for the correction of hyperglycemia. Pdf diabetic ketoacidosis dka, a lifethreatening complication of diabetes mellitus dm. Dehydration may be great in diabetic ketoacidosis, and intravenous fluids are usually needed as part of its. The goal of treatment is to correct the elevated blood glucose level by giving additional insulin and to replace fluids and electrolytes lost through excessive urination and vomiting. Diabetic ketoacidosis dka, a common cause of severe metabolic acidosis, remains a lifethreatening condition due to complications of both the disease and its treatment. Article pdf available in the indian journal of pediatrics 785. Updates in the management of diabetic ketoacidosis the. Pathophysiology of diabetic ketoacidosis 2018 nursing.
Providers who understand the pathophysiology of dka along with critical. Prior to the introduction of insulin to clinical medicine by banting and best in 1922, dka had a mortality rate greater than 60% 2. Diabetes mellitus is a group of metabolic disorders characterized by the presence of chronic hyperglycemia accompanied by greater or lesser impairment in the metabolism of carbohydrates, lipids. Pathophysiology of dka involves reduction of the effective insulin concentrations in the. Pathophysiology of diabetic ketoacidosis rosival 2015. Diabetic ketoacidosis is characterized by a serum glucose level greater than 250 mg per dl, a ph less than 7. Hirsch practices in the department of emergency medicine at the university of coloradodenver. Developments in the management of diabetic ketoacidosis in. Nurse practitioners are well positioned to promote patient education, selfmanagement, and individualized patient care. The last century has been characterised by remarkable advances in our understanding of the mechanisms leading to hyperglycaemia. Ketoacidosis is a serious complication of diabetes. Diabetic ketoacidosis dka is a lifethreatening complication affecting 3046% of children with newly diagnosed type 1 diabetes in the u.
Diabetic ketoacidosis dka is an acute, major, lifethreatening complication of diabetes characterized by hyperglycemia, ketoacidosis, and ketonuria. Dka onset and recurrence can largely be prevented through patient education. The usual defects contributing to type 2 diabetes are further complicated by the natural physiological. Diabetic ketoacidosis can occur in persons of all ages. Whatyoushouldknow diabeticketoacidosis dkaisacommon,serious,andpreventablecomplicationoftype1diabetes,withamortalityof35%. Diabetic ketoacidosis also known as dka is one of those harder topics to learn in nursing school. Even small amounts of insulin can turn off ketoacid formation.
Oct 28, 2015 to the editor of british medical journal. An update of its etiology, pathogenesis and management ebenezer a. Errors in the management of dka are not uncommon and are associated with significant morbidity and mortality. Diagnosis, management and the importance of prevention.
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 source. Introduction diabetic ketoacidosis dka is a potentially life threatening complication in people with diabetes mellitus. What is the pathophysiology of diabetic ketoacidosis. It happens predominantly in those with type 1 diabetes, but it can occur in those with type 2 diabetes under certain circumstances. Article information, pdf download for diabetic ketoacidosis. It is conceptualized that dka occurs most often in patients with type 1 diabetes but this is not true. The metabolic derangements and treatment of diabetic. Diabetic ketoacidosis pathophysiology pdf diabetestalk. Diabetic ketoacidosis pathophysiology on the web most recent articles. Hyperglycemia causes an osmotic diuresis with significant fluid and electrolyte loss. Without insulin, glucose will not be transported to the cells. Ispad 2009, mcgeoch 2007, savage 2006, bsped 2004, kitabchi 2009. Current concepts in the pathophysiology and management of. Recently, retrospective2 and prospective3 studies of the use of bicarbonate in the treatment of severe ph of 6.
Diabetes mellitus is a complex metabolic disorder associated with an increased risk of microvascular and macrovascular disease. 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. Diabetic ketoacidosis can occur in persons of all ages, with 14 percent of cases occurring in persons older than 70 years, 23 percent in persons 51 to 70 years of age, 27 percent in persons 30 to. Diabetic ketoacidosis is a common illness among patients with diabetes. Therefore, it becomes vital that the healthcare professional be able to manage the hyperglycemic crises. They are part of the spectrum of hyperglycemia, and each represents an extreme in the spectrum. The immediate cause of coma in diabetic ketoacidosis is very low bloodph and its increase with alkalizing solutions is a successful treatment of diabetic ketoacidotic coma. The pathophysiology of dka in patients with t1d will first be addressed, followed by a discussion of proper emergency treatment for this life. Approach to the treatment of diabetic ketoacidosis american. Evidence implicating excess stress hormone secretion as a necessary event in the development of severe metabolic. The central role of insulin in glucose metabolism regulation was clearly demonstrated. Adapted with permission from wolfsdorf j, glaser n, spearing ma.
Dka is responsible for more than 500,000 hospital days per year 2,3. The author has disclosed no potential conflicts of interest, financial. The data both supporting and negating a primary role for insulin deficiency in the pathogenesis of diabetic ketoacidosis are examined. View enhanced pdf access article on wiley online library html view download pdf for offline viewing. Diabetic ketoacidosis dka is an emergency for people with diabetes characterized by hyperglycemia, metabolic acidosis, and ketosis. The number of people diagnosed with diabetes is approximately 1. Risk calculators and risk factors for diabetic ketoacidosis pathophysiology.
Habtamu wondifraw baynes, lecturer clinical chemistry. Diabetic ketoacidosis pathophysiology 2018 diabetic ketoacidosis also known as dka is one of those harder topics to learn in nursing school. Diabetic ketoacidosis is a serious complication of diabetes mellitus type 1. Diabetic ketoacidosis at diagnosis of type 1 diabetes. Pathophysiology and clinical guidelines the academy of dental learning and osha training, llc, designates this activity for 7 continuing education credits 7 ces. Classification, pathophysiology, diagnosis and management of diabetes mellitus habtamu wondifraw baynest university of gondar, ethopia corresponding author. May 31, 2019 diabetic ketoacidosis dka is an acute, major, lifethreatening complication of diabetes characterized by hyperglycemia, ketoacidosis, and ketonuria. Diabetic ketoacidosis dka is not a rare presentation to hospital, despite being an entirely preventable condition. Diabetic ketoacidosis dka is a serious complication of type 1 diabetes and, much less commonly, of type 2 diabetes. Diabetic ketoacidosis is due to a marked deficiency of insulin in the face of high levels of hormones that oppose the effects of insulin, particularly glucagon. Some of the major complications of dka are related to its treatment box 3. Sign up today to have full access to our comprehensive catalog of medical training videos. Older adults are at high risk for the development of type 2 diabetes due to the combined effects of genetic, lifestyle, and aging influences. Updates in the management of diabetic ketoacidosis the journal.
Diabetic ketoacidosis dka most commonly results from uncontrolled type 1 diabetes, but may occur in patients with type 2 diabetes. It can happen when your blood sugar is too high for too long. Because cerebral edema is the most common cause of mortality and morbidity, especially in children with dka, we. Some people with diabetes can treat diabetic ketoacidosis at home. Diabetic ketoacidosis dka, though preventable, remains a frequent and life threatening complication of type 1 diabetes.
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