DIABETIC KETOACIDOSIS
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Diabetic Ketoacidosis - Pediatric - Lecture Slides, Slides of Pediatrics
Complete lecture series on Pediatric is available at docsity for students to download for free. This lecture key points are: Diabetic Ketoacidosis, Goals, Clinical Diagnosis, Treatment and Controversies, Infiltration of Islets, Progression, Typical Presentation, Polyuria, Polydypsia, Rapid-Deep Respiration, Diagnostic Criteria
Typology: Slides
2012/2013
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DIABETIC KETOACIDOSIS
GOALS
• REVIEW TYPE 1
DIABETES AND
METABOLISM AS
THEY RELATES TO
DKA
- CLINICAL DIAGNOSIS and MISLEADING LABS
- TREATMENT and CONTROVERSIES
- TREATMENT GUIDELINES docsity.com
Progression to Type 1 DM
Autoimmune destruction
“Diabetes threshold”
Honeymoon
100% Islet loss
Typical Presentation
- Polyuria, polydypsia, weight loss
- Vomiting
- Rapid-deep respiration
- CNS depression – coma
- Precipitating event
Background
- 15-30% of new diabetics present in DKA
- < 4 yrs of age = 40% with DKA @ diagnosis
- Most common cause of death in diabetics less than 20 years of age - 70% of related deaths in diabetics less than 10 yrs of age
- Mortality: 5-15% (1-2% at MEDCEN)
- Preventable
Diagnostic Criteria
- Blood glucose > 250 mg/dl
- pH < 7.
- HCO 3 < 20 mEq/L
- Anion Gap > 12
- ketonemia
Etiology
DKA violates rules of common sense
- Increased insulin requirement despite decreased food intake
- Marked urine output in setting of dehydration
- Catabolic state in setting of hyperglycemia and hyperlipidemia
- Insulin Deficiency is the Primary defect
- Stress hormones accelerate and exaggerate the rate and magnitude of metabolic decompensation
Pathophysiology
Counter-Regulatory Hormones
Pathophysiology Hormone
- Impaired insulin secretion Epi
- Anti-insulin action Epi, cortisol, GH
- Promoting catabolism All
- Dec glucose utilization Epi, cortisol, GHdocsity.com
Pathophysiology
Insulin
Glucagon
Epinephrine
Cortisol
Growth Hormone
Pathophysiology
Dec Glucose Utilization Lipolysis
Insulin
Glucagon
Epinephrine
Cortisol
Growth Hormone
Pathophysiology
Gluconeogenesis Glycogenolysis Lipolysis Ketogenesis
Insulin
Glucagon
Epinephrine
Cortisol
Growth Hormone
docsity.com
- Insulin Deficiency Glycogenolysis Gluconeogenesis Hepatic glucose output Peripheral glucose uptake Elevates blood glucose Lipolysis Release FFA -> liver VLDL & ketones Ketonemia and hyperTG Acidosis & Diuresis
DKA - Late Increased Production &
Decreased Utilization Fasting hyperglycemia
9 yo lab Evaluation
- Blood Gas - pH 7.0 5/1.
Glu >1000, (+) Ketones
9 yo lab Evaluation
- Blood Gas - pH 7.0 5/1.
Glu >1000, (+) Ketones