DKA

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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.

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DKA

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

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