Diagnosis and procedures

(Diabetic ketoacidosis, Myocardial Infarction & intubation)



Diagnosis and procedures

Diabetic ketoacidosis

Diabetic ketosis is a complication of diabetes and a state of relative and absolute deficiency of insulin which is usually life threatening, major and acute. It usually occurs in patient having diabetes i.e. when the body has no insulin to use. It is also common in patients suffering from type 2 diabetes. It is mainly aggravated by ensuing acidosis producing derangements in intermediary metabolism, hyperglycemia and dehydration.DKA is often associated with significant disturbance of the chemistry of the body, and it usually resolves from proper therapy (Mrozik & Yung, 2009).

Causes

The most common cause of DKA is missed insulin treatments, concomitant or underlying infections and previously unknown or newly diagnosed diabetes.

In Type 2 diabetes patients DKA is mainly causes by some medications such as clozapine, corticosteroid and pentamidine and, some other intercurrent illnesses such as pneumonia, UTI, myocardial infarction and prostatitis. Whereas the people having Type1 diabetes mellitus include brittle diabetes, mechanical blockage of insulin infusion pump, the leading cause of bacterial infections is the Klebsiella pneumoniae resulting in precipitating Diabetic ketosis, insulin infusion, catheter blockage, idiopathic (no identifiable cause), surgical, medical or emotional stress, acute insulin deficiency, intercurrent illnesses and bacterial infections eg infection of urinary tract or vomiting (Lin & Huang, 2005).

Symptoms

Diabetic ketosis itself is a symptom of undiagnosed diabetes and the first sign is hyperglycemia. Typical symptoms of diabetes include:

Dehydration

Vomiting

Confusion or comma

Deep laboured breathing

Frequent urination

General weakness

Increased heart rate

Dry mouth and skin

Abdominal pain

Low blood pressure

Investigation and diagnosis

Whenever ketones in the blood, Hyperglycemia (elevated blood sugar level) and acidosis are demonstrated together in combination, Diabetic ketoacidosis can be diagnosed. Urine and blood test helps to diagnose Diabetic ketoacidosis .The blood samples are taken to measure creatinine levels, electrolytes and urea.

Pathophysiology

The diabetic ketosis is characterized by ketoacidosis, hyperglycemia and ketonuria. It is a complex disordered metabolic state. It occurs due to the deficiency of insulin (maybe relative or absolute).This insulin deficiency accompanies elevation in counter regulatory hormones such as growth hormone, glucagon, cortisol and epinephrine. This hormonal imbalance causes glycogenolysis, hepatic gluconeogenesis(which are secondary to insulin deficiency resulting in elevated levels of sugar)and lipolysis(elevates the serum free fatty acids).

Osmotic dieresis, metabolic acidosis, hyperglycemia and serum hyper osmolarity result i9n sever electrolyte imbalance. The chief disturbance is loss of potassium in the body. This loss occurs due to transfer of potassium from extracellular and intracellular spaces in exchange with ions of hydrogen that accumulate extracellularly in acidosis. Loss of potassium observed in urine causes osmotic diuresis. This pathophysiologic disturbance in DKA is directly measurable by health care physicians and the need for monitoring it throughout the course of treatment is a must.

Treatment

Treatment of diabetic ketoacidosis involves checking the blood sugar levels regularly with administering insulin in order to suppress the ketone bodies that the body manufactures and also inducing intravenous fluids to treat dehydration. These are the most critical and primary initial treatments from diabetes ketoacidosis.

Treatment of other underlying causes of DKA must also be addressed; including ...