Diabetic Ketoacidosis

Endocrine System


Clinicals - History

Fact Explanation
{"ops":[{"insert":"Definition"},{"insert":"\n"}]}
{"ops":[{"insert":"Diabetic ketoacidosis (DKA) is an acute, life-threatening metabolic disturbance, characterized by hyperglycemia, metabolic acidosis, and ketonemia. It is the result of relative or absolute insulin deficiency, accompanied by an excess of counter-regulatory hormones including glucagon, cortisol, catecholamines and growth hormones."}]}
{"ops":[{"insert":"Gastrointestinal symptoms"},{"insert":"\n"}]}
{"ops":[{"insert":"Nausea and vomiting are the most common symptoms of DKA. DKA can often manifest with non-specific abdominal pain and ileus, sometimes mimicking an acute abdomen. This is thought to be caused by hypovolemia-induced mesenteric ischemia and delayed emptying."}]}
{"ops":[{"insert":"Decreased level of consciousness"},{"insert":"\n"}]}
{"ops":[{"insert":"Lethargy, somnolence, or stupor is present in half of cases of DKA due to intracellular glucose starvation and the inability to convert ingested food into energy. Patients with severe DKA can present with loss of consciousness."}]}
{"ops":[{"insert":"Polydipsia, polyphagia, and polyuria"},{"insert":"\n"}]}
{"ops":[{"insert":"Many patients will have undiagnosed diabetes melitus, which is characterised by the classic triad of hyperglycemic symptoms: polyphagia, polyuria and polydipsia.\n\nThe state of insulin deficiency drives tissue catabolism which keeps the satiety centre of the brain activated. This increases appetite and food intake resulting in polyphagia. Persistent hyperglycemia causes osmotic diuresis resulting in frequent urination. This depletes total water reserves in the body, which induces thirst and wanting to drink, leading to polydipsia."}]}
{"ops":[{"insert":"Precipitating factors"},{"insert":"\n"}]}
{"ops":[{"insert":"Unless it is the initial presentation of diabetes mellitus, DKA rarely occurs without a precipitating event. Specific symptoms and signs will reflect any underlying illness such as infection, ischemia, surgery, pregnancy, eating disorders, and carbohydrate metabolism-altering drugs."}]}
{"ops":[{"insert":"History of diabetes"},{"insert":"\n"}]}
{"ops":[{"insert":"Most people presenting with DKA have a history of type 1 diabetes mellitus. The most common cause of DKA is omission of insulin which may result from non-adherence to insulin therapy or insulin pump failure.\n\nType 2 diabetes patients who develop DKA have impaired beta cell function that is more commonly seen in middle-aged males and people of black or Latin ethnicity, or in people who are overweight or obese. About 1\/3 of patients with DKA will have newly diagnosed diabetes. This is especially true in young children."}]}
{"ops":[{"insert":"Definition"},{"insert":"\n"}]}
{"ops":[{"insert":"Diabetic ketoacidosis (DKA) is an acute, life-threatening metabolic disturbance, characterized by hyperglycemia, metabolic acidosis, and ketonemia. It is the result of relative or absolute insulin deficiency, accompanied by an excess of counter-regulatory hormones including glucagon, cortisol, catecholamines and growth hormones."}]}
{"ops":[{"insert":"Gastrointestinal symptoms"},{"insert":"\n"}]}
{"ops":[{"insert":"Nausea and vomiting are the most common symptoms of DKA. DKA can often manifest with non-specific abdominal pain and ileus, sometimes mimicking an acute abdomen. This is thought to be caused by hypovolemia-induced mesenteric ischemia and delayed emptying."}]}
{"ops":[{"insert":"Decreased level of consciousness"},{"insert":"\n"}]}
{"ops":[{"insert":"Lethargy, somnolence, or stupor is present in half of cases of DKA due to intracellular glucose starvation and the inability to convert ingested food into energy. Patients with severe DKA can present with loss of consciousness."}]}
{"ops":[{"insert":"Polydipsia, polyphagia, and polyuria"},{"insert":"\n"}]}
{"ops":[{"insert":"Many patients will have undiagnosed diabetes melitus, which is characterised by the classic triad of hyperglycemic symptoms: polyphagia, polyuria and polydipsia.\n\nThe state of insulin deficiency drives tissue catabolism which keeps the satiety centre of the brain activated. This increases appetite and food intake resulting in polyphagia. Persistent hyperglycemia causes osmotic diuresis resulting in frequent urination. This depletes total water reserves in the body, which induces thirst and wanting to drink, leading to polydipsia."}]}
{"ops":[{"insert":"Precipitating factors"},{"insert":"\n"}]}
{"ops":[{"insert":"Unless it is the initial presentation of diabetes mellitus, DKA rarely occurs without a precipitating event. Specific symptoms and signs will reflect any underlying illness such as infection, ischemia, surgery, pregnancy, eating disorders, and carbohydrate metabolism-altering drugs."}]}
{"ops":[{"insert":"History of diabetes"},{"insert":"\n"}]}
{"ops":[{"insert":"Most people presenting with DKA have a history of type 1 diabetes mellitus. The most common cause of DKA is omission of insulin which may result from non-adherence to insulin therapy or insulin pump failure.\n\nType 2 diabetes patients who develop DKA have impaired beta cell function that is more commonly seen in middle-aged males and people of black or Latin ethnicity, or in people who are overweight or obese. About 1\/3 of patients with DKA will have newly diagnosed diabetes. This is especially true in young children."}]}

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