Diabetes is a disorder in the utilization of sugar, protein, and fats in the body due to insulin resistance or insulin deficiency. This disease is extremely prevalent. One report puts the prevalence anywhere from 0.5 to greather than 10 percent of the population.3 The prevalence is increasing as the population ages and is becoming more overweight. There are two forms of this terrible disease. Type one diabetes is characterized by immune-mediated destruction of beta cells leading to an absolute deficiency of insulin. Type 2 diabetes is a relative insulin deficiency that can eventually lead to beta cell distruction. Since insulin is required for uptake of sugar into cell, a deficiency leads to elevated blood glucose levels and eventually
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Insulin is required for complete catabolizism of carbs and a deficiency leads to disordered breakdown. This incomplete catabolism leads to ketones in the body. This can eventually lead to diabetic ketoacidosis.
CASE PRESENTATION
Mrs. T is a 60 yo female with a history of DM type 2 and CAD, that presented to the ER with a chief complaint of an abscess on her right buttock. An incision and drainage was performed in the ER and the culture of the wound was performed. A CBC, CMP, and a blood glucose were also performed. Her CBC showed an anion gap of 27 and a blood sugar of 349. She had a fever of 101 and elevated white count and a low blood pressure. She was subsequently admitted to the ICU with a diagnosis of diabetic ketoacidosis (DKA) and septic shock. She was started on IV normal saline to treat DKA an d …show more content…
It is commonly seen in Type 2 diabetics. To be diagnosed with diabetic ketoacidosis a patient must meet certain diagnostic criteria. These criteria include the sugar must be above 250 mg/dl. Also the blood pH must be below 7.3 and the bicarb level below 18 mEq/L or less. Another diagnotic test is the presessence of serum ketones. Beta hydroxybutarate is another test that can be performed and is actually a better measurement than ketones. It is also important to check serial BMPs. This is done for several reasons. One reason is the acidosis causes an efflux of potassium out of the cells leading to hyperglycemia. This hyperglycemia can lead to other complications such as cariac arrthymyias. Magnesium and phosphorus may also need to be replaced. It also also important to monitor the serum anion gap. When the gap has closed is when you know that the patient is no longer in DKA. You should also monitor the sugar as it
Insulin is required for complete catabolizism of carbs and a deficiency leads to disordered breakdown. This incomplete catabolism leads to ketones in the body. This can eventually lead to diabetic ketoacidosis.
CASE PRESENTATION
Mrs. T is a 60 yo female with a history of DM type 2 and CAD, that presented to the ER with a chief complaint of an abscess on her right buttock. An incision and drainage was performed in the ER and the culture of the wound was performed. A CBC, CMP, and a blood glucose were also performed. Her CBC showed an anion gap of 27 and a blood sugar of 349. She had a fever of 101 and elevated white count and a low blood pressure. She was subsequently admitted to the ICU with a diagnosis of diabetic ketoacidosis (DKA) and septic shock. She was started on IV normal saline to treat DKA an d …show more content…
It is commonly seen in Type 2 diabetics. To be diagnosed with diabetic ketoacidosis a patient must meet certain diagnostic criteria. These criteria include the sugar must be above 250 mg/dl. Also the blood pH must be below 7.3 and the bicarb level below 18 mEq/L or less. Another diagnotic test is the presessence of serum ketones. Beta hydroxybutarate is another test that can be performed and is actually a better measurement than ketones. It is also important to check serial BMPs. This is done for several reasons. One reason is the acidosis causes an efflux of potassium out of the cells leading to hyperglycemia. This hyperglycemia can lead to other complications such as cariac arrthymyias. Magnesium and phosphorus may also need to be replaced. It also also important to monitor the serum anion gap. When the gap has closed is when you know that the patient is no longer in DKA. You should also monitor the sugar as it