DKA

Diabetic Ketoacidosis(DKA)

Dr. Hossein MoravejDKA is the end result of the metabolic abnormalities resulting from a severe deficiency of insulin or insulin effectiveness.

DKA prevalence:In USA: - 14% of Hospital Admissions of All Diabetics. - 16% of Diabetic Mortality. - In 15 mEq/L. pH > 7.3. Persistent acidosis may indicate inadequate insulin or fluid therapy, infection, or rarely lactic acidosis. Urine ketones may be positive long after ketoacidosis has resolved because the nitroprusside reaction routinely used to measure urine ketones by dipstick measures only acetoacetate.

During DKA, most excess ketones are -hydroxybutyrate, which increases the normal ratio to acetoacetate from 3 : 1 to as high as 8 : 1. With resolution of the acidosis, -hydroxybutyrate converts to acetoacetate, which is excreted into the urine and detected by the dipstick test.

DIFFERENTIAL DIAGNOSIS OF DKA Cerebrovascular accident Brain stem hemorrhage Hypoglycemia Uremia Salicylates poisoning Gastroenteritis Pneumonia Starvation. Organic Acidemias.Ethanol or methanol poisoning