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diabetic ketoacidosis


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When the body lacks insulin?
Cells cannot transport glucose out of the bloodstream and into themselves
cells cannot transport glucose out of the bloodstream and into themselves because?
glucagon tells cells not to use glucose from outside, but to instead secrete non-carbohydrate sources that can be used to make glucose, on which RED BLOOD CELLS are absolutely dependent and the BRAIN mostly dependent for energy
Some amino acids can be converted to glucose (by gluconeogenesis), so those sources are typically locally available
the only source in MUSCLE tissue
the liver can also use the "glycerol backbone" made available in its FAT processing
even in the face of adequate fat stores
muscle will be broken down to make glucose
In starvation situations, the liver must produce another form of fuel. for brain fuel
The liver provides this by making ketone bodies from fats, then secreting them into the bloodstream.
In DKA, ketone bodies?
rapidly become a major component of the brain's fuel
As a result of the bloodstream being filled with an increasing amount of glucose that it cannot use (as the liver continues gluconeogenesis and exporting the glucose so made).
This significantly increases its osmolality
Osmolarity is a measure of
the osmoles of solute per litre of solution
osmolality is a measure of
osmoles of solute per kilogram of solvent. a mole of glucose in solution is one osmole, whereas a mole of sodium chloride in solution is two osmoles
At the same time, massive amounts of ketone bodies are produced, which in addition to increasing the osmolal load of the blood, are
As a result of increasing ketone bodies (inc. osmolality and inc. acidity)
the pH of the blood begins to change, Glucose begins to spill into the urine, As it does so, it takes a great deal of body water with it, resulting in dehydration.
Dehydration worsens the increased osmolality of the blood, and forces
water out of cells and into the bloodstream in order to keep vital organs perfused
Treatment consists of
hydration to lower the osmolality of the blood, replacement of lost electrolytes, insulin to force glucose and potassium into the cells, and eventually glucose simultaneously with insulin in order to correct other metabolic abnormalities, such as elevated blood potassium (hyperkalemia) and elevated ketone levels
vital signs, urine output, and blood tests
In patients with severe alteration of mental status
intubation and mechanical ventilation is required
In about a quarter of young people who develop type 1 diabetes, the insulin deficiency and hyperglycemia lead to
ketoacidosis before the disease is recognized and treated
As the ketosis worsens, it produces
metabolic acidosis, with anorexia, abdominal distress, and eventually vomiting
The rising level of glucose increases
the volume of urine produced by the kidneys (an osmolar diuresis)
Reduced fluid intake from vomiting combined with amplified urination produce
As the metabolic acidosis worsens, it induces
hyperventilation (termed Kussmaul respiration).

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