Ketoacidosis

Description:

Diabetic ketoacidosis (ketosis, ketoacidosis) — the option of a metabolic acidosis connected with disturbance of carbohydrate metabolism owing to deficit of insulin: high concentration of glucose and the ketonic bodies in blood (considerably exceeding physiological values) formed as a result of disturbance of exchange of fatty acids (lipolysis) and deamination of amino acids. If disturbances of carbohydrate metabolism are not stopped timely — the diabetic ketoatsidotichesky coma develops.
Not diabetic ketoacidosis (an atsetonemichesky syndrome at children, a syndrome of cyclic atsetonemichesky vomiting, atsetonemichesky vomiting) — set of the symptoms caused by increase in concentration in a blood plasma of ketonic bodies — the morbid condition which is found preferential at children's age, shown stereotypic repeated episodes of vomiting, the alternating periods of full wellbeing. Develops as a result of errors in a diet (long hungry pauses or excessive consumption of fats), and also against the background of somatic, infectious, endocrine diseases and defeat of TsNS. Distinguish primary (idiopathic) — 6% of children aged from 1 to 12 … 13 years and secondary (against the background of diseases) an atsetonemichesky syndrome meet at 4 ….
Normal in a human body as a result of standard metabolism ketonic bodies are constantly formed and utilized by fabrics (muscles, kidneys):
acetoacetic acid (acetoacetate);
beta and hydroxy-butyric acid (β-hydroxybutyrate))))))))));
acetone (пропанон).
As a result of a dynamic equilibrium their concentration in a blood plasma is normal scanty.

Ketoatsidoz's symptoms:

Ketoacidosis is a consequence with firmness of a dekompensirovanny diabetes mellitus and develops at heavy, its labile current against the background of:
accessions of intercurrent diseases,
pregnancies,
injuries and surgical interventions,
wrong and untimely dose adjustment of insulin,
untimely diagnosis for the first time the revealed diabetes mellitus.
The clinical picture is characterized by symptoms of the expressed disease decompensation:
level of a glycemia 15 … 16 mmol/l and above;
the glucosuria reaches 40 … 50 g/l and more;
ketonemiya 0,5 … 0,7 mmol/l and above;
the ketonuria develops;
at most of patients signs of the compensated metabolic acidosis are noted — the indicator of pH of blood does not overstep the bounds of physiological norm (7,35 … 7,45);
in more hard cases the subcompensated acidosis of which preservation of physiological mechanisms of compensation, despite decrease in pH is characteristic develops;
the decompensated metabolic acidosis develops at further increase of concentration of ketonic bodies that leads to exhaustion of alkaline reserves of blood — there comes the prekoma stage. Slackness, drowsiness, a loss of appetite, nausea join clinical symptoms of a decompensation of a diabetes mellitus (weakness, a polydipsia, a polyuria) (sometimes vomiting), the unsharp abdominal pain (an abdominal syndrome at a diabetes mellitus decompensation), in expired air is felt a smell of "acetone").
Diabetic ketoacidosis — the medical emergency demanding hospitalization of the patient. At untimely and inadequate therapy the diabetic ketoatsidotichesky coma develops.

Ketoatsidoz's reasons:

The diabetes mellitus of the 1st type is the most frequent reason of development of the expressed ketoacidosis. Diabetic ketoacidosis arises because of absolute or relative deficit of insulin which develops within several hours or days.
I. With for the first time the revealed insulin-dependent diabetes mellitus partial or full deficit of endogenous insulin is caused in patients by death of beta cells of pancreatic islands.
II. At the patients receiving insulin injections, can be the reasons of ketoacidosis:
1. inadequate therapy (purpose of too small doses of insulin);
2. disturbance of the mode of an insulin therapy (admission of injections, expired drug of insulin);
3. sharp increase in need for insulin at patients with an insulin-dependent diabetes mellitus:
a) infectious diseases: sepsis (or urosepsis); pneumonia; other infections of upper respiratory and uric ways; meningitis; sinuites; periodontitis; cholecystitis, pancreatitis; paraproctitis.
b) the accompanying endocrine disturbances: thyrotoxicosis, Cushing's syndrome, acromegalia, pheochromocytoma;
c) myocardial infarction, stroke;
d) injuries and/or surgical interventions;
e) medicamentous therapy: glucocorticoids, are oestrogenic (including hormonal contraceptives);
e) pregnancy;
g) a stress, especially in the teenage period.
In all above-mentioned cases increase in need for insulin is caused by the strengthened secretion of kontrinsulyarny hormones — adrenaline (noradrenaline), cortisol, a glucagon, STG, and also insulin resistance — the increased resilience of fabrics to effect of insulin.
III. At a quarter of patients the reason of development of diabetic ketoacidosis does not manage to be established.

Ketoatsidoz's treatment:

Ketosis. Medical tactics comes down to elimination of the reasons which provoked a ketosis, to restriction in a diet of fats, to purpose of alkaline drink (alkaline mineral waters, soda solutions, регидрон). Methionine reception, Essentiale, enterosorbents, Enterodesum is recommended (at the rate of 5 g dissolve in 100 ml of boiled water, drink for 1 — 2 time). If after the above-mentioned actions of ketoses is not eliminated, appoint an additional injection of insulin of short action (according to the recommendation of the doctor!). If the patient applied insulin in one injection a day, it is reasonable to switch over to the mode of the intensified insulin therapy. Recommend cocarboxylase (intramusculary), Spleninum (intramusculary) a course 7 … 10 days. it is reasonable to appoint alkaline cleansing enemas. If the ketosis does not cause special inconveniences hospitalization is optional — whenever possible carry out the listed actions in house conditions under control of specialists.
Ketoacidosis.
At the expressed ketosis and the phenomena of the progressing diabetes mellitus decompensation the patient needs hospitalization. Along with above-mentioned actions dose adjustment of insulin according to glycemia level is carried out, pass to administration only of insulin of short action (4 … 6 injections a day) subcutaneously or intramusculary. carry out intravenous drop infusions of isotonic solution of sodium of chloride (physical solution) taking into account age and a condition of the patient.
Patients with severe forms of diabetic ketoacidosis, stages of a prekoma are treated by the principle of a diabetic coma.