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Diabetic Ketoacidosis - Coggle Diagram
Diabetic Ketoacidosis
DKA can result in
Hyperglycemia
often more severe in DKA than an uncomplicated diabetic
results in
osmotic pull with intravascular water movement
causing hyponatremia
profound fluid loss
renal losses
GI losses
leads to
dehydration
hypovolemia
Ketonemia
Glucosuria and ketonuria
result in urinary losses of magnesium and calcium
Vomiting
Osmotic diuresis
hypokalemia
loss in the urine
shift of potassium stores into the extracellular space
decreased renal resorption
urinary loss leads to
potassium depletion
muscle weakness
arrhythmias
hemolysis
Hyperosmolar Hyperglycemic State (HHS)
extreme state of hyperglycemia (>600 mg/dL) and hyperosmolarity (>320‐350)
can occur in patients with decreased GFR, often from ...
cardiac
renal diseasw
↓ GFR = ↓Urinary Glucose Filtration = Severe Hyperglycemia (>600 mg/dL) = Severe Hyperosmolarity (>320‐350 mOsm/L)
SLOW DOWN volume resuscitation (36‐48 hours)
worse prognosis
Clinical Consequences (Summary)
Diabetes
PU/PD
polyphagia
protein catabolism,
hyperlipidemia
hepatic lipid deposition
glyogen deposition
Acidosis
vomiting
anorexia
diarrhea
lethargy
depression
abnormal ventilation
Fluid loss
dehydration
hypovolemia
Potassium loss = muscle weakness
Phosphate loss = hemolysis
Comborbidities
Present in 70‐90% of cases!
Pancreatitis is common in dogs & cats with DKA –
cPL or fPL (SNAP or Spec)
Ultrasound
Hyperbilirubinemia
hypoalbuminemia
:dog::cat:
Hyperadrenocorticism
PE findings
LDDST
ultrasound
Clinical signs
:dog:
Urinary tract infections
Urine culture is recommended for DKA patients
Kidney disease
:cat:
must be distinguished from pre‐renal azotemia –
“Fluid challenge,”
imaging
Other systemic inflammatory or infectious diseases c
Neoplasia
Pneumonia
Cholangiohepatitis
Pyometra or other severe infections
What is Diabetic Ketoacidosis (DKA)
definition
Ketosis
Metabolic Acidosis
Complication of Diabetes
basic physiology
Muscle and fat require insulin to move glucose into cells
Without insulin, these cells are in a starvation state
despite hyperglycemia there is ketone production
GLUT4 transporter
Counter‐Regulatory Hormones
Hormones that antagonize insulin
increase glucose production/release from stores
Gluconeogenesis
Glycogenolysis
contribute to the development of DKA
promote lipolysis and ketone formation
specific hormones
Glucagon
Growth Hormone
Cortisol
Ketones
transportable energy formed by the breakdown of fat stores
types of ketones
Acetone
Acetoacetate
Beta‐hydroxybutyrate
Urine dipsticks do not detect
unmeasured anion, therefore
High anion gap
therefore underestimate ketosis
metabolic acidosis
Acidosis has negative effects on
CNS (dullness)
gastrointestinal tract
anorexia
vomiting
diarrhea
respiratory tract (compensatory hyperventilation)
Therapy