Diabetic Ketoacidosis Flashcards
body responds to stress of decreased EVC
increasing epinephrine, cortisol, and GH–>block insulin –>further decrease insuline ffects
rising levels of plasma glucose case
osmotic diuresis–>decrease in ECV
because insulin is so low
glucagon is unopposed–>mobilize stores!–>increase glucose, muscle breakdown into alanine, fat lipolysis into free fatt acids
how do ketoacids form
increase hormone sensitive lipase–>release of FFA into circulation–>enter cells–>some metabolized to ATP by mito–>eventually NAD overwhlmed and FFA are used to make ketones (beta hydroxubutryase and acetoacetate)–>buffered–>overwhelm buffers->ketoacidosis
charactersitc, but w/ unclear cause, complications
abdominal pain
tx of diabetic coma
replete volume!
metabolic control via high dose insulin
how do you know when youre out of the water
normal anion gap
why is restoring volume important
restore bp–>decrease epi levels!
decrease osmolarity
lipolysis is
slow! (and this is fueling acidosis)–24 hrs of continuous insulint herapy
insulin wont bind well to receptor until
epi is down (volume repleated)
once acidosis clears, you need
K+ repletion (because K will plummet! by going into cells)
what breaks down into ketoacids
acetyl coa (has nowhere to go)
HONK usually happens
in people over 70 with limited self-care capability that have glucose over 1000 and lose 10-15 L of water (type 2 DM)
