ENDO Week 1 Objective 8

Insulin is required for cells to take up glucose from the blood. In the absence of insulin or if blood glucose and glycogen stores are exhausted ketogenesis is activated to make available energy that is stored as fatty acids as an alternate energy source for the brain.

Ketogenesis is the process by which ketone bodies are produced as a result of fatty acid breakdown.

Acetone

Polydipsia, polyuria,
Dehydration, hypotension, tachycardia
Hyperventilation
Vomiting
Abdominal Pain
Drowsiness
Coma

Kussmaul breathing is respiratory compensation for a metabolic acidosis by blowing off CO2. This can be observed in diabetics with ketonemia, diabetic ketoacidosis.

False

Ketosis is when the liver converts fat into fatty acids and ketone bodies which can be used by the body for energy, this should not be confused with ketoacidosis which is severe ketosis causing the pH of the blood to drop below 7.2.

Elevated above 11 mmol/L
This is because of some insulin impairment which traps the circulating blood glucose in the blood stream.

Decreased sodium, chloride, potassium, magnesium, phosphate.
-Potassium may appear to be high due to lack of insulin for cell uptake and acidosis causing exchange with H+
-Sodium may appear as falsely low due to osmotic effect of high glucose pulling water out of cells

Usually high, indicating pre-renal failure from hypovolemia

Elevated ketones, especially beta hydroxybutryrate

Low pCO2 from respiratory compensation of metabolic acidosis

Lack of insulin causes decreased inhibition of lipolysis and ketogenesis leading to increased ketone production and metabolic acidosis. Respiration increases to compensate for acidosis, serum hyperkalemia results from cellular balance of H+ and K+. Increased gluconeogenesis and glycogenolysis contribute to hyperglycemia that creates hyperosmolar serum causing diuresis and loss of electrolytes. Intracellular neurogenic osmoles created in brain to prevent dehydration (dangerous if fluid overload as not enough time to adjust, brain cells take up a lot of fluid, cerebral edema)

-Isotonic saline to restore blood volume,
-CO3- for acidosis,
-Insulin to stop gluconeogenesis and lipolysis.
-Add glucose IV as blood sugars begin to drop, with K+ to avoid hypokalemia.
-Monitor clinical signs and lab values. Do not fluid overload, could lead to cerebral edema, respiratory arrest and death.