Ketoacidosis, diabetic

NIDDM is a much more common disease than IDDM, accounting for about 85—90% of all cases of diabetes meUitus. Whereas NIDDM may be present at any age, the incidence increases dramatically with advanced age over 10% of the population reaching 70 years of age has NIDDM. Patients with NIDDM do not require insulin treatment to maintain life or prevent the spontaneous occurrence of diabetic ketoacidosis. Therefore, NIDDM is frequendy asymptomatic and unrecognized, and diagnosis requires screening for elevations in blood or urinary sugar. Most forms of NIDDM are associated with a family history of the disease, and NIDDM is commonly associated with and exacerbated by obesity. The causes of NIDDM are not well understood and there may be many molecular defects which lead to NIDDM. 

Insulin is necessary for controlling type 1 diabetes mellitus that is caused by a marked decrease in the amount of insulin produced by die pancreas. Insulin is also used to control the more severe and complicated forms of type 2 diabetes mellitus. However, many patients can control type 2 diabetes with diet and exercise alone or with diet, exercise, and an oral antidiabetic drug (see section Oral Antidiabetic Dmgp ). Insulin may also be used in the treatment of severe diabetic ketoacidosis (DKA) or diabetic coma. Insulin is also used in combination with glucose to treat hypokalemia by producing a shift of potassium from die blood and into die cells. 

The a-glucosidase inhibitors are contraindicated in patients with a hypersensitivity to the drug, diabetic ketoacidosis, cirrhosis, inflammatory bowel disease, colonic ulceration, partial intestinal obstruction or predisposition to intestinal obstruction, or chronic intestinal diseases. Acarbose and miglitol are used cautiously in patients with renal impairment or pre-existing gastrointestinal (GI) problems such as irritable... 

CBG Capillary blood gas corticosteroid-binding globulin DKA Diabetic ketoacidosis... 

Diabetic ketoacidosis A reversible but life-threatening short-term complication primarily seen in patients with type 1 diabetes caused by the relative or absolute lack of insulin that results in marked ketosis and acidosis. 

Hyperosmolar hyperglycemic state A potentially fatal short-term complication most commonly seen in older patients with type 2 diabetes caused by an insufficiency of insulin action that leads to alterations of osmolality and hyperglycemia, but without the ketosis and acidosis seen in diabetic ketoacidosis. 

Owen OE, Trapp VE, Skutches CL, et al. 1982. Acetone metabolism during diabetic ketoacidosis. 

Reichard GA, Skutches CL, Hoeldtke RD, et al. 1986. Acetone metabolism in humans during diabetic ketoacidosis. Diabetes 35 668-674. 

American Diabetes Association. Ketoacidosis. Available online. URL http //www.diabetes.org/type-l-diabetes/ketoacidosis.jsp. Accessed on March 18, 2008. 

Main pathophysiological mechanisms of iron loading that may result in an infectious risk 1.1 Increased gastrointestinal absorption of iron I.2a Parenteral administration of iron I.2b Increased release of iron in the blood stream (haemolysis) 1.3 Increased inhalation of iron II Chronic inflammation III Diabetic ketoacidosis increased... 

The following factors have been suggested as alternatives to consider when presented with a potential case of exposure to carbon monoxide diabetic ketoacidosis, hypothyroidism and myxedema coma, labyrinthitis, and lactic acidosis toxic exposures resulting in methemoglobinemia ingestion of alcohols or narcotics and diseases that cause gastroenteritis, encephalitis, meningitis, and acute respiratory distress syndrome. 

Hepatic encephalopathy Hyperbilirubinemia Hypocalcemia Hypercalcemia Hyperparathyroidism Hypoparathyroidism Thiamine deficiency (Wernicke s) encephalopathy Diabetic ketoacidosis Nonketotic hyperosmolar coma Phosphate depletion Hypoglycemia Hypoxemia Hypercapnia... 

Individuals with type 1 DM are often thin and are prone to develop diabetic ketoacidosis if insulin is withheld or under conditions of severe stress with an excess of insulin counterregulatory hormones. 

Between 20% and 40% of patients present with diabetic ketoacidosis after several days of polyuria, polydipsia, polyphagia, and weight loss. 

Mechanical obstruction Diabetes mellitus (diabetic ketoacidosis)... 

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