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This presentation was present by my friend during emergency posting seminar with Dr.Mohd. Kamal Mohd. Arshad. I upload this ppt here for all of us and my own reference too. Good luck in your life.

This presentation was present by my friend during emergency posting seminar with Dr.Mohd. Kamal Mohd. Arshad. I upload this ppt here for all of us and my own reference too. Good luck in your life.

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  • 1.  
  • 2. DIABETIC EMERGENCIES Nasruddin Kamaruddin Razzi Siti Suraya Sarah Aliah Shuhaida Rohaida Nurfauzani
  • 3. DIABETIC KETOACIDOSIS ROHAIDA CHE MOHD ABDULLAH RAZZI HAJEMI
  • 4.
    • Major medical emergency
    • Serious cause morbidity
    • In type 1 DM
  • 5.
    • Usually due to (causes) :
      • Unknown or newly diagnosed cases of type 1 diabetes
      • Missed or inadequate doses of insulin, or spoiled insulin
      • Intercurrent infection, lose their appetite, stop or drstically reduced their dose of insulin
      • Stress, with increasing insulin resistance and requirement eg: infection, trauma, surgery, myocardial infarction, and stroke.
  • 6. LACK OF INSULIN
    • 1. DECREASED CATABOLISM (glucose)
    • Hyperglycemia - fatigue
    • Glycosuria – vulvitis
    • Osmotic diuresis – polyuria, polidipsia
    • Salt n water depletion – tachycardia,
    • - hypotension
    • - dehydration
  • 7.
    • Dehydration with decreased perfusion to the tissues leads to lactic acidosis, which contributes to more profound acidosis.
  • 8.
    • 2. INCREASED ANABOLISM
    • Gluconeogenesis  - wasting
    • Glycogenolysis 
    • Lipolysis  - loss of weight
    • Hyperketonemia
    • Acidosis – hyperventilation
    • Peripheral vasodilation – hypotension, hypothermia
    • Diabetic Ketoacidosis
  • 9.  
  • 10.
    • 3. INCREASED SECRETION
    • Glucagon
    • Costisol
    • Cathecolamine
    • Growth hormone
    • ANTAGONIZED INSULIN
  • 11.  
  • 12.  
  • 13. DEATH !!!
  • 14. Clinical feature
    • As above…
    • Vomiting
    • Blurred vision
    • Abdominal pain (children)
    • Confusion, drowsiness
    • Cold peripheries /peripheral cyanosis
    • Ketone breath (smell of acetone)
    • Coma (uncommon)
  • 15.  
  • 16. METABOLIC ACIDOSIS
    • pH - <7.3 / 7.25 (  ) (N – 7.35-7.45)
    • HCO3 - ?
    • pH = log 6.1 + [HCO3-]
    • 0.03pCO2
    • HCO3 - (  )
  • 17. WHY develop hyperventilation?
    • The combination of ketoacid formation and dehydration results in metabolic acidosis, and, for compensatory alkalosis,
    • rapid deep breathing (Kussmaul respirations) may be manifested at advanced stages
    • Kussmaul breathing – to wash out the CO2. thus – patient develop hyperventilation
  • 18.
    • The resulting metabolic acidosis – forces the hydrogen ions into cells, displacing potassium ions (whish may lost in urine or through vomiting)
    • H + H + K +
    • K + H + H +
    K + H + K + H + K + H + K + K + K+
  • 19. Diagnostic Criteria
    • Random Blood Sugar > 11.1 mmol/L
    • Ketonemia > 90mg/dL , ketonuria >5000mg/24hr
    • Aterial blood gases, pH<7.3/7.25
    • HCO 3 <15 mmol/L
  • 20. INVESTIGATION
    • Random blood glucose
    • Arterial Blood Gases
    • Full blood count
    • Renal profile
    • CXR
    • ECG
    • Urine FEME
  • 21. COMPLICATION
    • Cerebral Edema (hyponatremia)
    • Aspiration pneumonia (coma)
    • Hypokalemia
    • Hypomagnesaemia
    • Hypophosphatemia
    • Thromboembolism
  • 22. REFERENCES
    • Oxford Handbook Clinical Medicine
    • Davidson’s principle and practice of medicine
    • Lippincott’s biochemistry
  • 23.  
  • 24. THANK YOU