ADVANCED P508

DKA •Is a life threatening condition with a rapid onset. •Occurs when there is an absolute lack of insulin (usually precipitated by physical or emotional stress—elevated cortisol) •Serum glucose levels rise extremely high. •Is usually seen in Type 1 diabetics. •Rarely seen in Type 2 diabetics. •Is sometimes (25-30%) the first indication that the person has diabetes. Mechanisms involved in DKA are as follows: •Lack of insulin leads to: oDecreased cellular uptake of glucose.  Resulting in increased serum glucose.  Resulting in fatty acid metabolism by cells (to generate energy). oIncreased hepatic gluconeogenesis.  Resulting in an increased serum glucose. oIncreased lipolysis.  To generate fatty acids for use as an energy source.  Fatty acid metabolism generates ketoacids which promote metabolic acidosis. oProteolysis.  Protein breakdown causes muscle wasting. Manifestations in DKA •Polyuria oSame mechanism as with general diabetes, but stronger due to the higher serum glucose. •Polydipsia oDue to severe dehydration. •Hypokalemia oPotassium is lost in the urine and shifted into the cells in exchange for hydrogen in an effort to correct the acidosis. •Hyperglycemia