uncovering the basis of a severe degree of acidemia in a patient with diabetic ketoacidosis by m....

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Uncovering the basis of a severe degree of acidemia in a patient with diabetic ketoacidosis by M. Gowrishankar, A.P.C.P. Carlotti, C. St George-Hyslop, D. Bohn, K.S. Kamel, M.R. Davids, and M.L. Halperin QJM Volume 100(11):721-735 October 30, 2007 © The Author 2007. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: [email protected]

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Page 1: Uncovering the basis of a severe degree of acidemia in a patient with diabetic ketoacidosis by M. Gowrishankar, A.P.C.P. Carlotti, C. St George-Hyslop,

Uncovering the basis of a severe degree of acidemia in a patient with diabetic ketoacidosis

by M. Gowrishankar, A.P.C.P. Carlotti, C. St George-Hyslop, D. Bohn, K.S. Kamel, M.R. Davids, and M.L. Halperin

QJMVolume 100(11):721-735

October 30, 2007

© The Author 2007. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: [email protected]

Page 2: Uncovering the basis of a severe degree of acidemia in a patient with diabetic ketoacidosis by M. Gowrishankar, A.P.C.P. Carlotti, C. St George-Hyslop,

Overview of the biochemistry and physiology of ketoacidosis.

M. Gowrishankar et al. QJM 2007;100:721-735

© The Author 2007. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: [email protected]

Page 3: Uncovering the basis of a severe degree of acidemia in a patient with diabetic ketoacidosis by M. Gowrishankar, A.P.C.P. Carlotti, C. St George-Hyslop,

Uncoupling of oxidative phosphorylation and hepatic ketogenesis.

M. Gowrishankar et al. QJM 2007;100:721-735

© The Author 2007. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: [email protected]

Page 4: Uncovering the basis of a severe degree of acidemia in a patient with diabetic ketoacidosis by M. Gowrishankar, A.P.C.P. Carlotti, C. St George-Hyslop,

Balance for H+ and β-HB− when ketoacids are accumulating.

M. Gowrishankar et al. QJM 2007;100:721-735

© The Author 2007. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: [email protected]

Page 5: Uncovering the basis of a severe degree of acidemia in a patient with diabetic ketoacidosis by M. Gowrishankar, A.P.C.P. Carlotti, C. St George-Hyslop,

Indirect loss of NaHCO3.

M. Gowrishankar et al. QJM 2007;100:721-735

© The Author 2007. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: [email protected]

Page 6: Uncovering the basis of a severe degree of acidemia in a patient with diabetic ketoacidosis by M. Gowrishankar, A.P.C.P. Carlotti, C. St George-Hyslop,

Buffering of H+ in the brain in a patient with a contracted ‘effective’ arterial blood volume.

M. Gowrishankar et al. QJM 2007;100:721-735

© The Author 2007. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: [email protected]

Page 7: Uncovering the basis of a severe degree of acidemia in a patient with diabetic ketoacidosis by M. Gowrishankar, A.P.C.P. Carlotti, C. St George-Hyslop,

Time course for the rise in the PHCO3 in this patient.

M. Gowrishankar et al. QJM 2007;100:721-735

© The Author 2007. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: [email protected]