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Diabetic Ketoacidosis (Symptoms (Polyuria and polydipsia, Nausea and…
Diabetic Ketoacidosis
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Treatment plan
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Insulin (inhibits lipolysis, ketogenesis, acidosis, reduces hepatic glucose production, increase tissue glucose uptake)
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Investigations
- Hyperglycaemia (plasma glucose usually <50 mmol/l)
- Raised plasma ketones (urine ketones > 2+)
- Metabolic acidosis - plasma bicarbonate < 15 mmol/l
K is high on presentation despite total body K deficit (due to acute shift of K out of cell with acidosis), subsequently fall with insulin and dehydration, anticipate fall in K
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Urinary ketones dipstick >2+ ketones, blood ketones >3
Causes
Triad of hyperglycaemia, ketones, acidosis
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Pathophysiology
Uncontrolled catabolism (break down) associated with insulin deficiency
- Increase in free fatty acids, which are broken down to acetyl-coenzyme A within hepatocytes, which in turn is converted into ketone bodies within the mitochondria