Diabetic ketoacidosis Flashcards
beta oxidation occurs where
Krebs cycle in mitochondria
insulin prevents fatty acids moving into mito
what happens when you inhibit insulin like in type 1
insulin not amiable to prevent beta oxidation leading to lots of palmitoyl coA through that enzyme now free to go inside cell and now used to make energy
3 ketone bodies
acetone - volatile - gas - smell in breath
acetoacetate
beta-hydroxybrutyrate
in dka what do we see
low insulin
no inhibiting of fatty acid transport
low insulin in dka is
going to lead to High glucose so dehydration and osmotic diuresis will occur
potassium goes up in serum, total body potassium depleted though
acidosis
dehydration leading to increase creatine due to renal failure
serum ketones and beta hydrolyse rate
anion gap formula
The anion gap (AG) is a derived variable primarily used for the evaluation of metabolic acidosis to determine the presence of unmeasured anions (e.g. albumin is the main unmeasured anion). The normal anion gap varies with different assays but is typically between 4 to 12 mmol/L.
cause of high include DKA
The anion gap is an artificial measure that is calculated by subtracting the total number of anions (chloride & HCO3–) from the total number of cations (Na+). There are lots of other anions and cations, however, those shown in brackets have the most significant influence, which is why other cations (e.g. K+) and anions (e.g. albumin, phosphate) are not used in the calculation of the anion gap.
Anion gap formula: Na+ – (Cl– + HCO3–)
triad of DKA
this all leads to potassium body depletion leading to dehydration
ketonaemia above 3mmol or significant ketonuiria more than 2 + on stick)
blood glucose above 11 or know diabetes mellitus
bicarb under 15 and or venous pH below 7.3
what is DKA
pathological process resulting from insulin deficiency due t bodies inability to metabolise glucose
newly diagnosed type 1 diabetics often present in DKA
triggers of DKA
Infection, such as flu or a urinary tract infection (UTI) Poor compliance with treatment plan, such as missing doses of insulin Injury or surgery Drugs such as steroids Binge drinking Using illegal drugs Pregnancy Menstruation
alcohol starvation diets such as anti epileptic diets medications toxins
what cause potassium to leave cells
hyperosmolarity
exercise
cell lysis
soft in caused by insulin and beta agonists
i.e. high glucose could be high potassium
so if no insulin more insulin in th e extracellular fluid so high levels of potassium
first ketone produced by the body and created from the breakdown of fatty acids and measure in urien
acetoacetate
most prevalent ketone in our body and the most energy efficient measured directly by blood ketone meter
beta-hydroxybutyrate
what ketone is virtually useless to the body and excreted through the breath measured with an breath meter
acetone
dka
patient with acidic blood
dehydrated
excess potassium in their blood
but a total body potassium deficit
kussmaul breathing
deep and laboured breathing pattern with tachypnoea
ketosis and acidosis and resp comp