Diabetic Ketoacidosis Final PDF

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Summary

diabetes explained in detail from the pathology to the differenal diagnosis...

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Diabetic Ketoacidosis (DKA) Definition

Ketoacidosis is a metabolic state that is associated with pathologically high urine and serum concentrations of ketone bodies [1] Diabetic ketoacidosis (DKA) is a complication that occurs from uncontrolled diabetes mellitus. If not diagnosed and treated early, it will become life threatening [1]. DKA is mainly found in individuals with type 1 diabetes as they produce high levels of blood acids called ketones [2]. This then develops when the body has an absolute insulin deficiency which is worsened by hyperglycaemia, dehydration, and acidosis. DKA is also relative to high counter- regulatory hormone concentrations which result in accelerated catabolic state with increased glucose production in the kidney and liver [2]. Diabetic ketoacidosis is usually triggered by new on-set diabetes, infection, and lack of treatment [2].

Clinical Features

When identifying Diabetic Ketoacidosis clinicians find that the most distinctive clinical feature is high blood glucose levels (>10mmol/L) and dehydration [3]. Other features that can indicate DKA include tachycardia, excessive urination (Polyuria), tachypnoea (which can be mistaken as asthma or pneumonia) and/or have Kussmaul respiration [3]. This is identified by the smell of ketones in breath which is caused by fat metabolism. Patients may also seem confused, drowsy, ALOC and potentially become unconscious if left untreated [1]. It is important to monitor the neurological status of patients who present with DKA as they may go from full alertness then show signs of significant decrease to profound lethargy and coma. [1].

Aetiology

Diabetic Ketoacidosis is extremely common with patients with Type 1 diabetes, and it affects around 30-40% of children who are newly diagnosed [3]. It occurs when there is a build-up of ketones in the blood, and it is more common in young people and women [3]. Newly diagnosed cases of DKA were found in children younger than 2 years old, who were of a lower socioeconomic status and didn’t have accessible medical services [4]. Having limited access to healthcare medical diagnosis can be delayed and when left untreated causes an increase of significant issues. Some extremely common risk factors that precipitate the development of extreme hyperglycaemia and subsequent ketoacidosis include non- adherence to insulin therapy, infection, myocardial infarction, trauma, and the intake of particular medications [4]. These medications include glucocorticoids or antipsychotic agents that may have the potential to affect the metabolism of carbohydrates [4]. More risk factors that are affected by DKA are insulin omission, acute gastroenteritis with constant vomiting and inability to stay hydrated, poor metabolic control, and psychiatric disorders such as eating disorders [4]. Diabetic ketoacidosis is one of the main causes of morbidity and mortality amongst diabetic patients. Statistics show that in 2017 there were 222,340 administrations of DKA in hospitals [5]. The highest administration of DKA patients were 65 years (...