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13 Cards in this Set

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What leads to the activation of metabolic ketogenic ATP generating pathways?
Insulin is required for cells to take up glucose from the blood. In the absence of insulin or if blood glucose and glycogen stores are exhausted ketogenesis is activated to make available energy that is stored as fatty acids as an alternate energy source for the brain.
Define Ketogenesis.
Ketogenesis is the process by which ketone bodies are produced as a result of fatty acid breakdown.
Which ketone body is clinically detectable during a physical exam?
Acetone
What clinical features would you expect to find during your physical exam of a diabetic patient with ketoacidosis?
Polydipsia, polyuria,
Dehydration, hypotension, tachycardia
Hyperventilation
Vomiting
Abdominal Pain
Drowsiness
Coma
Why do people with ketoacidosis appear to be hyperventilating? What is this breathing called.
Kussmaul breathing is respiratory compensation for a metabolic acidosis by blowing off CO2. This can be observed in diabetics with ketonemia, diabetic ketoacidosis.
True or False

Ketoacidosis is the same as ketosis.
True or False

Ketoacidosis is the same as ketosis.
False

Ketosis is when the liver converts fat into fatty acids and ketone bodies which can be used by the body for energy, this should not be confused with ketoacidosis which is severe ketosis causing the pH of the blood to drop below 7.2.
Laboratory Results for ketoacidosis:
Glucose
Elevated above 11 mmol/L
This is because of some insulin impairment which traps the circulating blood glucose in the blood stream.
Laboratory Results for ketoacidosis:
Electrolytes
Decreased sodium, chloride, potassium, magnesium, phosphate.
-Potassium may appear to be high due to lack of insulin for cell uptake and acidosis causing exchange with H+
-Sodium may appear as falsely low due to osmotic effect of high glucose pulling water out of cells
Laboratory Results for ketoacidosis:
Urea
Usually high, indicating pre-renal failure from hypovolemia
Laboratory Results for ketoacidosis:
Ketones
Elevated ketones, especially beta hydroxybutryrate
Laboratory Results for ketoacidosis:
Blood Gasses
Low pCO2 from respiratory compensation of metabolic acidosis
Ketoacidosis: Pathophysiology
Lack of insulin causes decreased inhibition of lipolysis and ketogenesis leading to increased ketone production and metabolic acidosis. Respiration increases to compensate for acidosis, serum hyperkalemia results from cellular balance of H+ and K+. Increased gluconeogenesis and glycogenolysis contribute to hyperglycemia that creates hyperosmolar serum causing diuresis and loss of electrolytes. Intracellular neurogenic osmoles created in brain to prevent dehydration (dangerous if fluid overload as not enough time to adjust, brain cells take up a lot of fluid, cerebral edema)
How would you treat diabetic ketoacidosis?
-Isotonic saline to restore blood volume,
-CO3- for acidosis,
-Insulin to stop gluconeogenesis and lipolysis.
-Add glucose IV as blood sugars begin to drop, with K+ to avoid hypokalemia.
-Monitor clinical signs and lab values. Do not fluid overload, could lead to cerebral edema, respiratory arrest and death.