Diabetic Ketoacidosis Caused by an absence or markedly inadequate amount of insulin in the body. Diabetic ketoacidosis occurs most often in patients with type 1 diabetes the amount of glucose entering in the cell for energy consumption is inadequate, thus our body begins to burn fats as alternative source of energy. Free fatty acids and glycerol (product of lipolysis) are converted into ketones in the liver, this ketones are acidic. Ketones are acids that build up in the blood and appears in the urine when the body have inadequate insulin. Increase level of ketones in blood is a warning manifestation that you diabetes is worsening. Stress also triggers production of glucose, interfering the utilization of glucose in the muscle and fat tissue, thus increasing the level of ketones through lipolysis.

Pathophysiology

Decrease in amount of insulin in the body may affect the amount of glucose level that enters in our cell, this may trigger our liver through gluconeogenesis to release glucose and may lead to hyperglycemia. In attempt to get rid of the excess glucose in our system, our kidney attempt to excrete excess glucose together with urine and other electrolyte such as potassium. This osmotic diuresis is characterized by excessive urination and may lead to dehydration and electrolyte loss, which will manifested with body weakness and headache. Because of excessive urination, our body will attempt to replace the fluid loss by activating the thirst mechanism that will result to polydipsia. Insufficient amount of insulin in our system, will result to decrease consumption of glucose as our primary source of energy, thus our body will look for another source of energy and that is fats, this fats will be converted to free fatty acids through lipolysis and there will be an increase in fatty acids in our body, this fatty acids will be then converted in our liver into ketone bodies, this ketones are acidic, thus accumulation of ketones in our circulation may cause acidosis due to lack of insulin, leading to metabolic acidosis. Too much ketone will manifest fruity breath odor. Nausea, vomiting and abdominal pain are the major indication of G.I tract problem that are commonly seen in patient with DKA. Due to acidosis, our body will try to compensate by excreting carbon dioxide through respiratory system as manifested by Kussmaul respiration.

Lack of Insulin

*Decreased utilization of glucose by muscles, fats and liver.*Increased production of glucose by liverIncrease breakdown of fats

Increased Fatty AcidsHyperglycemia

Blurred VisionIncrease Ketone BodiesPolyuria

DehydrationAcidosis*Acetone Breath*Poor Appetite*Nausea

Increase thirst(POLYDIPSIA)WeaknessHeadache

Increasingly rapid respirations*Nausea*Vomiting*Abdominal Pain

Clinical Manifestation

Excessive thirst- due to excessive urination, to replace fluid loss cause by activated thirst mechanism Frequent urination- the kidney trying to neutralized the glucose level in the blood through urination. General weakness- because of the electrolytes that are excreted and insufficient glucose for energy consumption Vomiting- gastrointestinal symptoms of ketosis and acidosis Abdominal pain- manifestation of severe condition that they resemble an acute abdominal disorder that requires surgery. Hyperventilation- represents the bodys attempt to decrease the acidosis, counteracting the effect of the ketone build up. Dry skin and mouth Increased heart rate- due to depletion of blood volume. Orthostatic hypotension due to depleted intravascular volume Distinctive fruity odor on the breath- because of high level of ketones in the blood.

Diagnostic Procedure and Findings

Blood Glucose Level-to determine if the body have enough insulin to allow sugar to enter your cells, your blood sugar level will rise (hyperglycemia). As your body breaks down fat and protein for energy, your blood sugar level will continue to rise.300-800 mg/dL

Ketone level.When your body breaks down fat and protein for energy, toxic acids known as ketones enter your bloodstream.Small: < 20 mg/dLModerate: 30 - 40 mg/dLLarge: > 80 mg/dL

Blood acidity.If you have excess ketones in your blood, your blood will become acidic (acidosis) with a pH of 6.8-7.3 and low partial pressure of carbon dioxide (10-30mmHg).Normal pH value 7.35- 7.45 Urinalysis- to determine the presence of ketones.Normal Result- Negative

Creatinine and Blood Urea Nitrogen and Hematocrit may increase as a result of dehydration.

Diagnostic Criteria of Diabetic Ketonacidosis

Diagnostic criteria

Mild DKAModerate DKASevere DKA

Plasma glucose>250 mg/dl>250 mg/dl>250 mg/dl

Arterial pH7.25-7.307.00-