dka - Hyperglycemia syndromes Diabetic Ketoacidosis...

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Hyperglycemia syndromes Diabetic Ketoacidosis Diabetic Ketoacidosis Ketoacidosis-Hypersomolar Coma Ketoacidosis-Hypersomolar Coma UTHSCSA Pediatric Resident Curriculum for the PICU UTHSCSA Pediatric Resident Curriculum for the PICU
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Spectrum of DKA and Hyperosmolar Coma Pure Ketoacidosis Ketoacidosis- Hyperosmolar Coma Pure Hyperosmolar Coma Rapid Onset Marked Insulin Lack Intermediate Slow Onset Mild Insulin Lack
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Diabetic Ketoacidosis Hyperglycemia Ketonemia Metabolic Acidosis
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Pathophysiology Insulin Deficiency is the primary defect in patients with DKA Muscle Hepatocyte Adipose Glucose Amino Acids Glucose-P Glycogen Pyruvate, CO 2 Glucose Free fatty acids Ketoacids Normal Insulin Activity
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Insulin Deficiency Breakdown of storage forms of energy to meet energy needs. (Catabolism) Glycogenolysis Lipolysis Gluconeogenesis (from amino acids, lipids) Glucagon unopposed by Insulin stimulates this catabolic reaction
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Pathophysiology Skeletal and cardiac tissues are able to use free fatty acids and ketone bodies as an energy source. Glucose can not be used by these tissues in the absence of insulin. The brain is an insulin-independent tissue and continues to use available glucose.
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Persistent Catabolism Hyperglycemia is worsened by further intake of glucose. Excess Ketone bodies from Lipolysis Acetone β -hydroxybutyrate (BHB) Acetoacetate (AA) Ratio of BHB/AA normally 3:1 is driven to 15:1 in severe DKA Ketone test measures only acetoacetate
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Hyperosmolar State Hyperglycemia acts as an osmotic diuretic with obligatory loss of water and electrolytes. Osmolality = 2(Na) + Glucose/18 + BUN/2.8 (normal 293 ) Ketosis/hyperglycemia stimulate vomiting with aggravation of dehydration
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Hyperosmolar State Hypovolemia secondary to dehydration can promote decreased tissue perfusion with anaerobic metabolism and elevated lactate production Total fluid deficit in severe DKA usually averages around 10% of the total body weight
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Electrolyte Loss Glucose Ketoacids Ketoacids draw out intravascular cations of Sodium and Potassium Intracellular exchange of potassium with hydrogen ions H + K + Phosphorous is also depleted in the osmotic diuresis K I D N E Y
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dka - Hyperglycemia syndromes Diabetic Ketoacidosis...

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