Pathophysiology Of Diabetic Ketoacidosis Essay Discussion
a. Present your initial diagnosis.
b. Describe the pathophysiologic explanation(s) to support your diagnosis and the clinical symptoms presented.
c. List the test(s) you would perform to confirm your diagnosis, the rationale for each test ordered, and the results you would expect if your diagnosis is correct.
d. Describe your recommended treatment(s) and the rationale to support your recommendation(s) Pathophysiology Of Diabetic Ketoacidosis Essay Discussion.
According to given information the client is suffering from” Diabetic ketoacidosis”
This conditions occur due to the sever insulin deficiency. The main clinical symptoms are Hyperglycemia, dehydration, ketosis and acidosis. It occurs when the body start breaking down fat at a rare at a rare that is much to fast. The liver processes the fat into a fuel called ketones ,which cause the blood become acidic.
The client is suffering from Diabetic ketoacidosis because in question mentioned that the client feels tired and weak, polyuria, drinking more water , lose weight 8 ponds and fruit like smell these all symptoms indicates the client suffering from Diabetic ketoacidosis.
Ans b) pathophysiology of diabetic ketoacidosis:-
Diabetic ketoacidosis is the result of a critical relative or absolute deficiency of insulin, resulting in intracellular starvation of insulin dependent tissues (muscle, liver, adipose), stimulating to release counter- regulatory hormones .
– the lack of insulin and corresponding elevation of Glucagon leads to increase release of Glucose by the liver (process that is normally suppressed by insulin) from glycogen via Glycogenolysis and also though Gluconeogenesis
– high glucose level spill over into the urine, taking water and aolutes (such as sodium and potassium) along with it in a process know as Osmotic diuresis.
-this leads to polyuria, dehydration, and compensatory thirst and polydipsia
-the absence of insulin also leads to the release of free fatty acids from adipose tissues (lipolysis) which are converted through a process called beta oxidation, again in the liver, into ketone bodies (acetoacetate and betahydroxybutyrate)
-beta hydroxybutyrate can serve as an energy source in the absence of insulin mediated glucose delivery and is protective mechanism in case of starvation.
– the ketone bodies have a low ph and therefore turn into the blood acidic ( metabolic acidosis).
-the body initially buffer change with the bicarbonate buffering system, but this system is quickly overwhelmed and other mechanism must work to compensate for the acidosis.
-one such mechanism is hyperventilation to lower the blood carbon dioxide level (a form compensatory respiratory alkalosis)
Lack of insulin leads decrease glucose utilization. The counterregulatory hormone works. Glucagon leads –
-lipolysis, ketogenesis, ketoacidosis.
-Glucagon also leads Glycogenolysis and Glycogen genesis leads hyperglycemia, osmotic diuresis and dehydration Pathophysiology Of Diabetic Ketoacidosis Essay Discussion
- Abdominal pain
- Shortness of breath
- Dehydration/ hypotension
- Fruity odour smell
- Kussmaul respiration
- Weight loss
- Dry skin
- Sunken eyes
These symptoms are occur due to decrease insulin and excess secreation of glucagon and other counterregulatory hormones.
Ans c) lab investigation
- Serum glucose level
- Serum electrolyte level
- Bicarbonate level
- Ketones level
- Amylase and lipase level
- Urine dipstick
- ABG measurements
- CBC count
- Urine and blood culture.
In Diabetic ketoacidosis :-
- Serum glucose above300mg/dl
- Serum ketones positive
- Serum ph less than 7.35
- Serum bicarbonate less than 15mmol/lit
- Serum sodium low
- BUN above 20mg/dl
- Chest radiography
- Head CT scanning
- Head MRI
Chest radiography – to rule out pulmonary infection.
Head CT scan-
Head CT scan- stand to detect early cerebral edema, use low threshold in children with diabetic ketoacidosis and altered mental status. ct early cerebral edema, use low threshold in children with diabetic ketoacidosis and altered mental status.
Head MRI – to detect early cerebral edema
Ans d) treatment:-
Initial hospital management:-
- Replace fluid and electrolytes
- Iv insulin therapy
- Watch for complication
- Convert to home insulin regimen
- Prevent reacurrance
To prevent diabetic ketoacidosis conditions
To prevent dehydration and fluid electrolytes imbalance
Insulin therapy to maintain normal insulin level
- Avoid impending shock
- Rapid fluid replacement has been associated with edema
- Initially fluid bolus of 5-7 ml/kg over 30-60 min.
- Start with normal saline then switch to dextrose 5% with 1/2 normal saline, when glucose drop to 250mg/dl.
- Insulin should be given through intravenous route and continue till acidosis and dehydration resolved.
- Insulin drip 0.075-0.1u/kg/hr.
- Dextrose should be added to intravenous fluid when serum glucose less than 250.
To treat the diabetic ketoacidosis conditions adequately without and problem.
The client initially diagnosis is diabetic ketoacidosis. This condition develop due to deficiency of insulin. The main clinical manifestation include hyperglycemia, dehydration, ketosis, and acidosis.
The diagnosis include lab finding such as serum glucose level, serum ph, serum ketones level, CBC count, serum sodium, potassium and bicarbonate level etc.
The treatment of disease provide insulin therapy and fluid therapy to treat dehydration and hyperglycemia. Pathophysiology Of Diabetic Ketoacidosis Essay Discussion