Ketoacidosis diagnosis, Diabetic Ketoacidosis
- Blood needed to prepare the serum.
- The urine sample may also be used.
- Ketone bodies are advised in patients with diabetes mellitus.
- The advice in case of uncontrolled diabetes mellitus.
- In ketoacidosis associated with alcoholism, starvation, and a high protein diet.
- In ketoacidosis, there is inhibition of glycolysis while glycogenolysis and gluconeogenesis are stimulated.
- There are hyperglycemia and deranged acid balance and electrolyte imbalance.
- Ketone bodies substrate is free fatty acids from the adipose.
- Long-chain fatty acids are taken up by the liver.
- In the liver are reesterified to triglycerides and stored in the liver.
- Or these are converted to very-low-density lipoprotein and returns to the blood.
- infants have earlier ketonuria than adults after decreased food intake.
- In uncontrolled diabetes mellitus:
- low insulin level leads to:
- increased lipolysis.
- Decreased reesterification.
- There are increased plasma free fatty acids.
- Insulin and glucagon ratio changes.
- This ratio is changed and enhances fatty acids oxidation
- It leads to increased ketone bodies formation in the liver and decreased peripheral tissue metabolism gives rise to accumulation in the blood.
- There is an accumulation of acetoacetate ketone bodies in the blood.
- low insulin level leads to:
Signs and Symptoms:
There may be :
- A cough.
- Chest pain.
Causes of ketone bodies formation:
- Frequent vomiting.
- Diabetes mellitus.
- Glycogen storage disease (von Gierke disease).
- During pregnancy.
Lab findings are:
- The glucose level may range from 300 to 500 mg/dL.
- Ketones bodies are beta-hydroxybutyric acid, acetoacetic acid, and acetone is positive.
- These are produced during gluconeogenesis, mainly due to increased fatty acid oxidation to acetyl CoA.
- Excessive concentration of ketone bodies in the blood is called ketonemia.
- When there is increased excretion in the urine is called ketonuria.
- Electrolytes show :
- Decreased Sodium.
- Increased Potassium.
- The anion gap is increased.
- Total CO 2 decreased.
- Blood gases shows:
- pH decreased.
- Metabolic acidosis.
- Bicarbonates are decreased.
Ketoacidosis and Diabetic ketosis:
|Glucose||300 to 500 mg/dL|
|Ketones||Positive (Acetone, Beta-hydroxybutyric acid and acetoacetic acid)|
|Total CO 2 decreased|
|Anion gap increased|
|Blood gases||pH decreased|
Method to detect ketone bodies
- Sodium nitroprusside reaction gives lavender color.
- This is very sensitive 10 times for acetoacetate than with acetone.
- It does not react with beta-hydroxybutyrate.
- Gerhardt’s ferric chloride test mainly measures the acetoacetate ketone body.
- Start with saline for volume replacement.
- Insulin infusion (but delay if serum potassium level is low <_3.3 meq/L).
- Potassium replacement when the serum level is <5.5 meq/L.
- Glucose drip (5% dextrose with 0.45% saline when the plasma glucose level is <250 mg/dL.
- Continue glucose and insulin until the anion gap is <12 meq/L.
- Try to find the causative agent