Talk:Diabetic ketoacidosis

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[edit] more re ketone bodies

The mechanism section does not clearly explain the pathophysiology of DKA. I am not an expert, but I believe the release of acidifying ketone bodies should be focused on.

[edit] name

Why does it say

and ketone bodies (acids)

Ketones aren't acids, are they? AxelBoldt 05:19 Feb 26, 2003 (UTC)

Ketone bodies include acetoacetate and b-hydroxybutyrate. Both of these compounds have acidic hydrogens on carbon 2, because of the adjacent carbonyl function. —The preceding unsigned comment was added by 137.53.182.171 (talk) 22:51, 27 April 2007 (UTC).
A ketone is a particular chemical type in biochemistry. The ketone bodies here are three chemicals, two of which are chemically ketones. One is not. Large quantities of these do acidify body fluids. The term comes from 'ketones of the body' and originated at a time at which the ketone breath, quite a distinct smell, was the distinguishing feature clinically. Hence the ketone 'bodies' terminology which is otherwise weird in biochemistry. Sorry it took me so long to notice this enquiry.
ww
Also, while ketone bodies are often considered acids, only two of the three are actually acidic: beta-hydroxybutyric acid and acetoacetic acid (acetone's only functional group is a ketone, so it isn't an acid). --David Iberri (talk) 20:21, 4 April 2007 (UTC)

[edit] reconciliation

This article needs to be reconciled with main diabetes mellitus article. Alex.tan 03:47, 5 Feb 2004 (UTC)


[edit] more on names

ww is incorrect here. They are called ketone bodies because they come from ketones. They are called ketoacids because they are both acid and ketone (well, beta-hydroxybutyrate is actually acid plus alcohol, but acetoacetate is both, and they're ketone bodies because they come from ketones.)

Devilbunny 22:02 18 Oct 2004 (UTC)

DB, The history is claimed to be as I suggested. The match between the chemistry and the terminology is the confusing bit.ww 21:42, 26 Nov 2004 (UTC)

[edit] Type 1 DKA episode

I've just returned from hospital aftr suffering dibetic ketoacidosis caused by insulin resistence due to a laceration infection (I've had type 1 diabetes for 20 years and have it under excellent control)... between 10am and 10pm i took 180 units of fast acting insulin into my body (Novorapid) on a normal day i take roughly 25-30 units of insulin. in less than 12 hours i went from having normal blood glucose range of 4mmol-7mmol to being seriously ill with ketoacidocis (dka). I don't have much background knowledge but as is written here type 2s can have dka, just not very often and it's also not unheard of for non diabetics to have a type of 'dka' (i'm aware that its often attributed to shock?) --this comment added 19 March 2007--

[edit] difficulties with recent edits

Recent edits have taken the position that lack of insulin causes DKA. And that the insulin/glucagon value is the key issue. And that glucagon affects cells generally and not merely those with mobilizable glycogen stores. etc All of these are questionable statements and should be reviewed. ww 21:42, 26 Nov 2004 (UTC)

I agree. For example, non-insulin dependent diabetics are initially insulin resistant and do not have an insulin deficiency. Such patient may also develop DKA, often precipitated by underlying infection. --Mvdw 15:30, 27 January 2007 (UTC)
WRONG. Type 2 diabetics do NOT develop DKA precicely because insulin is present. A complete lack of insulin is a requirement for DKA as even a tiny amount of serum insulin inhibits hepatic lipase, the enzyme which generates the acidic keytone bodies. Type 2 diabetics develop HONKC, which is a similar, but very different, clinical entity. —The preceding unsigned comment was added by 70.50.115.2 (talk) 00:24, 31 January 2007 (UTC).
Firstly, the term Type 2 diabetic is misleading, since many so-called Type 2 diabetics are insulin dependent. Secondly, a complete lack of endogenous insulin is virtually incompatible with life. The diagnosis of DKA rests upon hyperglycemia, acidosis and ketonuria. According to Kumar & Clarke, hyper-osmolar non-ketotic coma and diabetic keto-acidosis are two ends of a spectrum, rather than separate entities. Mvdw 15:31, 6 February 2007 (UTC)
Concur with Mvdw here. DKA is not unknown in Type 2, even some who still have some endogenous insulin production. ww 00:30, 8 February 2007 (UTC)
Everyone is a little wrong here. DKA is the direct result of both an insulin deficiency and glucagon excess. Conditions of hyperglycemia, acidosis, and ketonuria develop as a result of insulin deficiency. However, a complete lack of insulin is not a requirement for DKA. The very small % of Type 2 diabetics developing DKA will do so because of insulin deficiency. Please consult Harrison's if you are still unclear on the subject. glotris173 22:10, 22 February 2007 (UTC)

[edit] more trouble

I've just changed a sentence in the ketone body production section, as it was incoherent as it stands. Nevertheless, this section is still very dubious. It does not correspond to my understanding of the process (competitive inhibition of a step in the fat metabolism chain by a step in the protein degradation chain whilst making glucose from amino acids), but I hesitate to make canges when there are better infomred editors available. I invite them to step in and clean up what has become a most unsatisfactory article. ww 20:05, 24 April 2006 (UTC) hyerglycaemia and DKA are separate entities coexisiting due to inadequate insulin.130.209.6.40

[edit] Symptoms

There is no mentioning of the symptoms of DKA here, the article used to list them before though. I think it should be added as this article simply presents the pathophysiology of DKA. Jack Daw 19:45, 25 September 2006 (UTC)

Additionally, the section of symptoms that has been inputted is a complete mess. The syntax is terrible, and there are some major grammatical errors. I would attempt to change it, but some of the bullet points include contradictory statements and I don't know enough about DKA to know which parts to remove. Could somebody who is more knowledgeable please fix it?72.196.98.106 01:54, 28 June 2007 (UTC)

[edit] poor explanations

Some of the content is badly explained, irrelevant and even inaccurate, for example the last paragraph - the reason is not that the cell does not have enough glucose; it is that insulin inhibits hormone-sensitive lipase, the enzyme responsible for triglyceride breakdown in adipocytes, which results in release of fatty acids into the blood for subsequent oxidation in the tissues. Lack of this inhibition due to lack of insulin results in excessive triglyceride breakdown thus excessive fatty acids in the blood, and resultant ketoacidosis through mechanisms I unfortunately don't have time to go into - a well-informed person or expert is, I think, needed to clean up the article. Yazza 18:57, 14 November 2006 (UTC)

Concur. This article contains a goodly amount of fact, some relevant and some irrelevant, and still more speculation as to causation (or implication as to causation). It is generally the latter which causes the problems with the article. It needs help badly. I will add a low quality tag to it shortly if we haven't done better. ww 21:42, 26 December 2006 (UTC)

[edit] type 2 DKA

There is an impression that Type 2 diabetics cannot experience DKA. This is an error. Quite a non-trivial number of Type 2 diabetics require insulin, and whatever the exact mechanism of DKA -- and will some informed person PLEASE go throuhg this article and clean it up in this respect) it is connected with lack of internal insulin production. It is a clinical fact, aside from anything else, that Type 2 diabetics do report to Emergency rooms with DKA.

This is the reason for the rollbakc made today. ww 13:29, 28 May 2007 (UTC)

[edit] According to Dr. H. Peter Chase, M.D. (From his publication Understanding Insulin-Dependent Diabetes, 9th Edition)

Chapter 14 Ketonuria and Acidosis(Diabetic Ketoacidosis or DKA) bear with me as this material is dry and kind of long...

Taken verbatim:

" Causes of Ketonuria and Acidosis

One "emergency" in diabetes, low blood sugar(hypoglycemia), was discussed in chapter 5. The other emergency in ketonuria, the appearance of moderate or large ketones in the urine, which can lead to acidosis. The measurement of urine ketones is very easy(a dipstick) and was discussed in chpter 4. The lack of knowledge about when to measure urine ketones and what to do when they are positive, and and not having ketone sticks which have not expired available in the home, are the most common deficiencies in families referred to our center. These deficiencies can result in a serious episode of acidosis.

"Large" ketones are usually present in the urine for at least tour hours before the total body's acidity is increased (acidosis). Acidosis is very dangerous and people can go into a coma or die from it. It is the cause of 85% of hospitaliztions of children with known diabetes. The good news is that it is 98% preventable if people follow the instructions in this chapter and always remember to take their insulin shots. It is possible, with good knowledge and by following the instructions of this chapter, to never have a episode of acidosis.Acidosis can be prevented in a child who is known to have diabetes.

Ketonuria and acidosis are due to there not being enough insulin available to meet the body's needs. The three main causes are: 1)illnesses, 2)forgetting to take an insulin shot, 3)not enough insulin (see Table 1). With an illness, extra energy may be needed by the body. This cannot be made unless extra insulin is available to make the extra energy from sugar. If a shot is forgotten, insulin is not avaiable for the body. A lack of insulin could happen in a person coming out of the "honeymoon" period who has not had dosages adequately increased." -- This is the first three sections of Chapter 14, atarting on p. 137

I have had diabetes for 18 years and from my experince, you can indeed have DKA with insulin in your system and this seems to back me up. That diabetic kid 17:16, 8 June 2007 (UTC)

[edit]  ?? 'late symptoms'

If my blood sugar levels go higher than 12 sometimes I vomit, this is not only/always a symptom of late stage, life threatening ketoacidocis. You don't even have to be in diabetic ketoacidocis to vomit because of high BSL.


does anyone else agree that the 'signs and symptoms' refer to those of IDDM (type 1) and not DKA, which is an acute condition? ~~ —Preceding unsigned comment added by 130.209.6.40 (talk) 19:54, 25 October 2007 (UTC)