Diabetic Ketoacidosis

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When the body lacks insulin?

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Cells cannot transport glucose out of the bloodstream and into themselves

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cells cannot transport glucose out of the bloodstream and into themselves because?

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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

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Some amino acids can be converted to glucose (by gluconeogenesis), so those sources are typically locally available

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protein

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the only source in MUSCLE tissue

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the liver can also use the "glycerol backbone" made available in its FAT processing

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even in the face of adequate fat stores

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muscle will be broken down to make glucose

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In starvation situations, the liver must produce another form of fuel. for brain fuel

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The liver provides this by making ketone bodies from fats, then secreting them into the bloodstream.

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In DKA, ketone bodies?

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rapidly become a major component of the brain's fuel

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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).

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This significantly increases its osmolality

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Osmolarity is a measure of

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the osmoles of solute per litre of solution

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osmolality is a measure of

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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

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At the same time, massive amounts of ketone bodies are produced, which in addition to increasing the osmolal load of the blood, are

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acidic

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As a result of increasing ketone bodies (inc. osmolality and inc. acidity)

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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.

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Dehydration worsens the increased osmolality of the blood, and forces

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water out of cells and into the bloodstream in order to keep vital organs perfused

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Treatment consists of

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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

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monitoring

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vital signs, urine output, and blood tests

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In patients with severe alteration of mental status

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intubation and mechanical ventilation is required

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In about a quarter of young people who develop type 1 diabetes, the insulin deficiency and hyperglycemia lead to

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ketoacidosis before the disease is recognized and treated

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As the ketosis worsens, it produces

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metabolic acidosis, with anorexia, abdominal distress, and eventually vomiting

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The rising level of glucose increases

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the volume of urine produced by the kidneys (an osmolar diuresis)

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Reduced fluid intake from vomiting combined with amplified urination produce

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dehydration

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As the metabolic acidosis worsens, it induces

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hyperventilation (termed Kussmaul respiration).