Diabetic ketoacidosis: timely diagnosis and correction of the condition

– This is a pathological condition characterized by a pronounced increase in the level of glucose and ketone bodies in the blood against the background of decompensation of diabetes mellitus. At the same time, most patients receive adequate treatment for ketoacidosis already in a state of coma, which in 19% of cases is fatal. Therefore, every doctor should be able to diagnose and prescribe the necessary therapy for

in time, since the patient's life may depend on timely measures in many cases. This article on estet-portal.com describes the principles of clinical and laboratory diagnosis of

, as well as therapeutic measures aimed at correcting the pathological condition. What causes ketoacidosis in diabetic patients

The pathophysiological basis for the development of ketoacidosis is insufficient insulin levels in the body in a patient with diabetes mellitus.

1. Lack of adequate treatment of diabetes mellitus (use of inadequately low doses of insulin or no insulin therapy at all when indicated);
2. Acute infection;
3. A sharp deterioration in the general condition against the background of an acute pathology, for example, the development of a myocardial infarction in a patient with diabetes mellitus.
It is also necessary to take into account the technical possibility of failure of insulin pumps in patients with diabetes mellitus, which can lead to an inadequate decrease in blood insulin levels.

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Therapy of diabetes mellitus: principles of treatment and methods of insulin therapy. Ketoacidosis: typical clinical symptoms of the pathological condition

The clinical picture of ketoacidosis in most cases does not cause diagnostic difficulties.

1. Increased diuresis;
2. Nausea;
3. Abdominal or chest pain;
4. Tachycardia;
5. Weight loss (in case of undiagnosed or poorly controlled diabetes mellitus);
6. Fever (if the cause of ketoacidosis is an infection);
7. Impairment of consciousness;
8. Deep hyperventilation (Kussmaul type breathing);
9. Smell of acetone on inhalation.
In

, ketoacidosis is characterized by an increase in glucose levels above 15 mmol/l. But in some patients, in particular pregnant women, ketoacidosis can develop at lower glycemic values. Ketoacidosis is characterized by an increase in the level of ketone bodies in the blood.

determination of ketone antibodies in urine has no diagnostic value. Determination of ketone antibodies in urine is not diagnostic.

Ketoacidosis is characterized by a violation of the acid-base state, which is expressed in the development of metabolic acidosis.

Telegram Diagnostic search for ketoacidosis: what to investigate

Ketoacidosis must be differentiated from pathologies such as hypoglycemia, hypoglycemic hyperosmolar syndrome, lactic acidosis, uremic coma, vascular accidents. In addition, a condition similar to ketoacidosis may develop in patients who abuse alcohol on the background of discontinuation of alcohol, but there will be no hyperglycemia.

According to international recommendations, in order to identify the cause of ketoacidosis, the doctor must conduct an algorithm of diagnostic studies.

1. Lab tests:
A) determination of the level of glycemia;

B) determination of electrolyte levels: sodium, potassium, calcium, magnesium, phosphorus;

B) bacteriological examination of urine;

D) determination of CRP (C-reactive protein) and the level of blood leukocytes;

E) acid-base balance (if available);

E) determination of creatinine level.

Insulin resistance: why the hormone can't reach the cells In addition, if myocardial infarction is a possible cause of ketoacidosis, an ECG and blood troponin levels should be taken immediately.

Ketoacidosis management: principles of fluid therapy and insulin administration

Ketoacidosis therapy includes several components, which are based on the main pathogenetic links of ketoacidosis (in particular, dehydration and hyperglycemia). The following principles of correction of this pathology should be highlighted:

Infusion therapy:
1. is performed to rehydrate the patient and involves the parenteral administration of saline or Ringer's solution. In the presence of hypernatremia (plasma sodium > 155 mmol/l), a 0.45% NaCl solution should be used. The rate of introduction of solutions is 1000 ml for 30-60 minutes. Subsequently, it should be 500 ml / hour until the level of glycemia is less than 12 mmol / l. After that, you should switch to intravenous administration of 5% glucose solution (prevention of hypoglycemia).
Insulin Therapy:
2. During the first hour, the patient must receive rapid-acting insulin by continuous intravenous infusion (not bolus). Starting insulin dosage: 0.1 U/kg, after that they switch to insulin administration at a dose of 0.1 U/kg/hour. If necessary, the infusion rate can be adjusted so that the plasma glucose concentration decreases by 2 mmol/L/hour (Glycemic monitoring should be done every hour).
Insulin therapy can only be carried out against the background of a normal level of potassium in the blood.

If intravenous infusion of insulin is not technically possible, it can be administered intramuscularly. Starting dose:

of insulin, after which they switch to a dose of 0.1 U/kg, which should be administered every hour. Thank you for staying with estet-portal.com. Read other interesting articles in the "Endocrinology" section. You might also be interested in

Glycosylated hemoglobin: what you need to know about this indicator.

Guideline «Diabetic ketoacidosis" (2018).

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