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Acute complications of diabetes: Why do infection and lack of insulin trigger ketoacidosis?
DKA is a potentially fatal complication of diabetes that usually presents with nausea, vomiting, abdominal pain, shortness of breath, frequent urination, weakness, confusion, and occasionally loss of consciousness. The patient's breath may have a characteristic "fruity" or acetone odor. Symptoms often develop quickly, and people, especially those who have not had diagnosed diabetes, may experience DKA as the first noticeable sign of the condition.
"DKA most commonly occurs in people with type 1 diabetes, but it can also occur in people with other types of diabetes under certain circumstances."
How does ketoacidosis occur?
DKA is mainly caused by insufficient insulin. In order to compensate, the body will rely on burning fatty acids, which in turn produce acidic ketone bodies. Due to the lack of insulin, the liver releases excess glucose, causing high blood sugar levels, which escape into the urine and cause frequent urination and dehydration. At this time, the patient's desire to drink water increases, resulting in polydipsia.
"Once too many ketone bodies accumulate in the blood, the blood will become acidic, leading to metabolic acidosis."
How does infection trigger ketoacidosis?
Infection is considered to be one of the main triggers of DKA. When the body is infected, the need for insulin increases, and failure to provide adequate insulin can lead to the development of DKA. This is because inflammatory responses in the body promote insulin resistance, further exacerbating the increase in blood sugar.
Diagnosis and treatment
The diagnosis of DKA is usually based on a specific panel of laboratory tests, including high blood sugar, elevated levels of ketone bodies in the blood or urine, and the presence of acidosis. DKA is considered when test results show a blood glucose level greater than 250 mg/dL (13.8 mmol/L) accompanied by a low pH and the presence of ketones. The first step in treatment is to control blood sugar and ketone body production through intravenous fluid replacement and insulin.
The importance of careful management"For those with severely low pH, sodium bicarbonate may be considered, but its effectiveness remains unclear."
During the treatment of DKA, regular monitoring of the patient's blood sugar and electrolyte levels is essential, especially potassium. In some cases, low potassium levels may accompany the course of DKA treatment, which may lead to an increased risk of cardiac arrhythmias.
Why complications should not be underestimated
One of the most serious complications of DKA is cerebral edema, which is more common in pediatric patients. Cerebral edema usually occurs in association with dehydration, acidosis, and low carbon dioxide levels. When treatment is started, the brain may swell further due to rapid fluid replacement, causing increased internal neck pressure.
ConclusionDiabetic patients face the risk of DKA and need to monitor their physical condition at all times, especially when they feel unwell. For medical practitioners, understanding the mechanisms of these acute complications can enable more effective diagnosis and treatment. Are we adequately prepared to face these challenges?
