Diabetic ketoacidosis by dr Mohammed elmalki.pdf

Dka

1. DIABETIC
KITOACIDOSIS
By:Mohammed ABD.Almone2em

2. Tutorial contents
1 Definition and Prevalences
2 Risk-factors
3 Pathophysiology
4 Signs and symptoms
5 investigations
6 Management
7 Complications

3. DEFINITION
*it is a serious complication ,resulting from increased levels of ketone bodies in the
blood due to critically low insulin level which is triggered when diabetic patient under
physiological stress considering as a risk factors:
infection
missed insulin injection
cardiovascular diseases (heart attack)
new onset of diabetes in people
*PREVALENCES:
About25-30%of patients with type one diabetes compared to type 2 diabetes4-29%

4. PATHOPHYSIOLOGY
*Insulin is responsible for glucose up-taking by cells ;when insulin deficient:
1.glucose con not enter the cells -> it stays in blood causes *high blood sugar level
->while the cells are starving =In responsible to this metabolic starvation ->the body
increase the level of counter
regulatory hormones (glucagon -epinephrine -cortisol-growth hormones ->these
hormones :
1.Produce more glucose in attempt to supply energy to the cells by breaking down
glycogen( glycogenolysis )+ synthesis glucose from proteins and lipids
(gluconeogenesis) -> however the cells can not take the glucose and the will result in
more sugar in blood producing somatic diuresis.
2.they activate lipolysis of fats ->fatty acids for alternative energy ,these fatty aides
metabolism will result in ketone bodies (acetone-beta hydroxybutyrate).

5. SIGNS AND SYMPTOMS
1. SIGNS:
Dehydration (dry mouth- sunken eyes -in elastic skin)
Hypothermia
Kussmaul respiration
Hypotension
Rapid weak pulse
Fruity breath -> door of acetone
2.Symptoms:
Intense first
Polyuria
Nausea and vomiting

6. INESTIGATIONS
1.Blood sample:->blood glucose more than 250mg\DL.
Arterial blood gas ->low ph less than7.3
Serum bicarbonate less than 18 mEq\L
2.Others:
Chest x-ray for infections like pneumonia.
Urea and creatinine for renal status
WBCs high -> leukocytosis

7. MANAGEMENT
Fluid replacement
Insulin IV or IM
Potassium replacement
Antibiotic if infection is present

8. COMPLICATIONS
1 Hypotension -> lead to renal failure
2 Cerebral edema ->high blood glucose results in water
shifting from the intracellular fluids to the extracellular fluid
space( major risk factor for mortality in children with DKA)
3 Acute respiratory distress syndrome
4 Thromboembolism
* DKA lead to death as resulting in diabetic coma.

9. THANKYOU