Fluid and electrolyte management in Diabetic Ketoacidosis and Hyperosmolar Hyperglycaemic state in the emergency department Introduction Diabetes Mellitus is a growing issue for health care providers internationally. The World Health organization estimated in 2013 there were 347 Million diabetics worldwide, predicting that Diabetes will be the 7th leading cause of death by 2030 (WHO, 2013). In both type 1 and type 2 diabetes Mellitus, factors such as poor compliance with diet and medication, infection, acute medical or surgical illness or trauma can lead to poor glycaemic control, precipitating a hyperglycaemic emergency such as Diabetic Ketoacidosis (DKA) (Scobie & Samaras, 2009). In Type 2 Diabetes, another equally dangerous complication can occur called Hyperosmolar, hyperglycaemic state (HHS) (Dunning, 2009). Both DKA and HHS are characterized by dehydration resulting from osmotic diuresis (Kisiel & Marsons 2009), often compounded by the patient already being in a dehydrated state due to the underlying cause (Del Garcia-Pascual & Kidby, 2012). It is therefore imperative that when a patient presents to an emergency department, rehydration and electrolyte replacement forms an integral component of treatment. Monash Health has developed protocols to treat DKA and HHS, a large part of which focus on rehydration and electrolyte management. This review will discuss the mechanisms of Dehydration in DKA and HHS, the importance of an effective rehydration and electrolyte management in both conditions; examine the differences between DKA and HHS in terms of onset, volume deficit and electrolyte changes, and compare best practice recommendations with the policies currently adopted by Monash Health. What are DKA and HHS? DKA an... ... middle of paper ... ...=eds-live Pamaiahgari, P. (2014). Diabetic Ketoacidosis and Hyperglycaemic Hyperosmolar Nonketotic Syndrome: Clinician Information. The Joanna Briggs Institute. Retrieved from: http://www.Joannabriggs.org Raghaven, V. A. (2014). Diabetic Ketoacidosis treatment and management. Medscape references, Drugs diseases and procedures. Retrieved from: http://emedicine.medscape.com/article/118361-treatment#aw2aab6b6b2 Scobie, I., & Samaras, K. (2009) Fast Facts: Diabetes Mellitus (3rd Ed.) Retrieved from: http://monash.worldcat.org/title/fast-facts-diabetes-mellitus/oclc/797833912&referer=brief_results Venkatraman, R., & Singhi,S. C. (2006) Hyperglycemic Hyperosmolar Nonketotic Syndrome. Indian Journal of Paediactrics (Vol 73), 55-60. DOI: 10.1007 BF02758261 WHO (2013) Diabetes Fact sheet No. 312. Retrieved from http://www.who.int/mediacentre/factsheets/fs312/en/
3: Briscoe VJ, Davis SN (2006) Hypoglycaemia in Type 1 and 2 Diabetes: Physiology, pathophysiology and management. Clinical Diabetes, 24 (3), 115-121
Diabetic Ketoacidosis (DKA) is a serious disease with complications that may have fatal results in some cases. DKA is defined as an insulin deficiency that occurs when glucose fails to enter insulin into muscles such as: liver and adipose tissue. When there is an accumulation of ketones, it leads to metabolic acidosis which causes nausea and vomiting, as a result fluid and electrolytes are loss (Gibbs). There are many complications of diabetic ketoacidosis, some of the most prevalent are: Cerebral Edema, Hypolglycemia, and Acute Pancreatitis.
Diabetic Ketoacidosis (DKA) is a serious disease with complications that may have fatal results in some cases. DKA is defined as an insulin deficiency that occurs when glucose fails to enter insulin into muscles such as: liver and adipose tissue. When there is an accumulation of ketones, it leads to metabolic acidosis which causes nausea and vomiting, as a result fluid and electrolytes are lost (Gibbs). There are many complications of diabetic ketoacidosis, some of the most prevalent are: Cerebral Edema, Hypoglycemia, and Acute Pancreatitis.
The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. American Diabetic Association. (2003). Follow-up report on the diagnosis of diabetes mellitus. Diabetes Care, 26, 3160-3167. doi: 10.2337/diacare.26.11.3160
Diabetes is one of the leading chronic causes of deaths in children and adolescent’s in the United States. Diabetes mellitus is a group of diseases that is characterized by high levels of glucose in the bloodstream resulting from defects in insulin production, insulin action or even both (Overview, 1). Diabetes is a serious health issue and can be associated with premature death or serious complications. Timely diagnosed treatment of diabetes can delay or prevent any onset of long-term complications, such as damage to blood vessels, kidneys, gums, skin, teeth, and many other complications (Overview, 1). Diabetes can be difficult to deal with during the time of adolescence. People with diabetes or those who have family members with diabetes should be very well informed (Cho, 1).
Neu, A; Hofer, S.E., MD; Karges, Beate; Oeverink, Rudolf; Rosenbauer, J; Holl, R.W., MD. (Sept. 2009). Ketoacidosis at Diabetes Onset Is Still Frequent in Children and Adolescents: A multicenter analysis of 14,664 patients from 106 institutions. Diabetes Care, 32(9) 1647-8. Scholarly Journals. Retrieved from ProQuest Research Library.
I think you have correctly identified the diagnosis for this patient in having HHS with the symptoms that where present in the scenario. The main difference between DKA and HHS is that the urine contain no ketones. The patient urine is negative for ketones which is a clinical symptom of HHS. “The difference between DKA and HHS is that ketosis and acidosis generally don't occur in HHS, partly because of the different insulin levels"(Hinkle & Cheever, 2014, p.1445). "HHS the insulin level is too low to prevent hyperglycemia and subsequent osmotic diuresis but is high enough to prevent fat breakdown"(Hinkle & Cheever, 2014, p. 1445)."In DKA, no insulin is present and this promotes the breakdown of stored glucose, protein, and fat, which lead to
Type 2 Diabetes Mellitus is a chronic condition that is characterized by insulin resistance in the body and increased blood glucose levels, known as hyperglycemia (1, 2). Type 2 (T2) diabetes is more common than type 1, and its incidence worldwide is increasing (3). T2 diabetes mellitus commonly affects adults over the age of 45, however its prevalence in children is increasing (4). The cause of diabetes mellitus is multifactorial, and results in a complex pathophysiology (5). This essay will focus on the pathophysiology of type 2 diabetes and the range of associated presentations that result from these pathophysiological processes.
Diabetes affects 18.2 million people in the United States. It is often referred to by doctors as diabetes mellitus and described as, “… a metabolic disease in which the person has high blood sugar …” (Collazo- Clavell et all. 2009), either because the insulin is inadequate or the body’s cells don’t respond well to the insulin. The health and economic consequences of diabetes are considerable. The majority of people that have diabetes live in low and middle income countries, where the prevalence of the disease is high. There are three types of diabetes that are called type 1, type 2, and gestational diabetes. Although diabetes is a disorder, it can lead to other diseases such as heart attack, kidney failure or death. A person that has diabetes has to maintain a healthy lifestyle, by eating the right diet, controlling their blood sugar level, and be optimistic.
Migdalis, I., Leslie, D., Papanas, N., Valensi, P., and Vlassara, H. (2014). Diabetes Mellitus. International Journal of Endocrinology, 2014, 108419. http://doi.org/10.1155/2014/108419
Hyperglycemia alone in the setting of an acute illness and isolated glycosuria may be due to other causes.
This is a condition linked to insulin-deficient type 1 diabetes. Ketogenic diets are being tested is in the treatment of diabetes, with Type I and Type II diabetics responding well to being in ketosis.
Diabetic ketoacidosis also called DKA is a very serious and life threating complication of diabetes in which the body produces excessive blood acids called ketones. This condition occurs when there is not enough insulin in the body which prevents the transport of glucose into the cells for energy. When this happens the glucose then stays in the blood stream instead of entering the cells. The body must have glucose to make energy and every cell in the body needs energy to carry out its most basic tasks, therefore the body begins to breakdown fat and muscle to get its energy source. This causing the production of ketones which stay in the blood stream altering the body’s natural chemical balance sending it into acidosis.
Diabetes mellitus is a group of metabolic disorders which is characterized by hyperglycemia due to insulin deficiency or resistance or both reasons. (1) According to that diabetes mellitus can be divided as type I and type II. This is common and its incidence is rising, 171 million people had diabetes in 2000 it is expected this condition to be doubled in 2030. It is spread in all the countries and therefore has become a major burden upon healthcare facilities. (2)
“Diabetes Mellitus is considered as a metabolic disorder of multiple etiologies (genetic and environmental) (1)”. With diabetes there are different types such as, type 1, type 2, and gestational diabetes. Type 1 is caused by “insulin