Diabetic ketoacidosis Flashcards
What are the three main ketone bodies found in DKA?
Acetoacetate
Beta-hydroxybutyrate
Acetone
Which ketone gives the fruit-drops smell typical of DKA?
Acetone
What symptoms does high levels of beta-hydroxybutyrate give a patient?
Nausea
Vomiting
What are the two intermediate breakdown products of glucose that will accumulate in hepatocytes when insulin is deficient?
NADH+
Acetyl Co-A
What happens to excess acetyl-CoA that has not been directed into the citric acid cycle as glycolysis has been impaired by insulin deficiency?
Directed into ketogenesis instead, leading to DKA
Why does Kaussmal’s breathing occur in DKA?
Respiratory compensation for acidotic state - trying to reverse a fall in bicarbonate concentration, a rise in H+ ion concentration and saturation of the body’s ability to buffer
What is the definition of DKA?
An acute metabolic complication of diabetes caused by hyperglycaemia, hyperketonaemia and metabolic acidosis
What is the cause of DKA?
A consequence of absolute insulin deficiency accompanied by an increase of counter-regulatory hormones
What are some of the signs and symptoms of DKA?
Polyuria Polydipsia Fatigue Nausea Vomiting Abdominal pain Kaussmal's breathing Unconsciousness Coma
What are the three characteristics of DKA?
Hyperglycaemia
Hyperketonaema
Metabolic anion gap acidosis
When are ketones produced?
When there is excess lipolysis (e.g. from low insulin levels) causing increased levels of fatty acids
When these are oxidised in the liver by acetyl-CoA, ketones are produced
What does adrenaline do in states of insulin deficiency?
Stimulates glucagon release and lipolysis, increasing fatty acids but not ketones
What does cortisol do in states of insulin deficiency?
Stimulates gluconeogenesis in the liver from amino acids, glycerol, lactate and propionate
What 3 changes in urine can be detected in DKA?
Low pH
Glucose in urine
Ketones in urine
What might precipitate a DKA episode in a diabetic patient?
Sepsis Poor control Vascular event e.g. MI Pregnancy Alcohol abuse Drug abuse Trauma Acute pancreatitis
