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The acidosis cause the body to increase lung ventilation and rid the
Pathophysiology
Insulin Glucagon Epinephrine
Liver
Gluconeog Ketogenesis enesis
Muscle
Glucose Utilization
Adipose tissue Lipolysis
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profound dehydration and electrolyte imbalance associated with DKA
• As a result of acidosis and dehydration,however, the initial reported
values for these electrolytes may be higher than actual body stores.
• Glucagon is elevated fourfold to fivefold in DKA and is the most
influential ketogenic hormone.
• Despite the increased pathologic glucagon-mediated production of
Introduction
DKA is a syndrome in which insulin deficiency and glucagon excess combine to produce a hyperglycemic, dehydrated,acidotic patient with profound electrolyte imbalance
Pathophysiology
•
Insulin deficiency results in activation of lipase that increases
circulating free fatty acid (FFA) levels.
• Long-chain FFAs, now circulating in abundance as a result of insulin
ketones, the body acts as it does in any form of starvation, to decrease the peripheral tissue’s use of ketones as fuel. The combination of increased
ketone production with decreased ketone use leads to ketoacidosis.
problem
• what is the diagnosis • what is the reason of hyperkalemia and hyponatremia • what is the reason of Metabolic acidosis • how to dispose the disease if you are the ER doctor on call
magnesium, calcium, phosphorus, and other ions from the circulation into
the urine
• This osmotic diuresis combined with poor intake and vomiting produces
the normal process of re-esterification to triglycerides appears to correlate
directly with the altered glucagon/insulin ratio in the portal blood.
Pathophysiology
hour • physical exam: tachypnea,BP 150/90mmHg,HR:120bpm,SaO2:99% • ABG:PH:7.06,PaCO2:12mmHg,PaO2:117mmmHg,HCO3-
:3.4mmol/L,Lactate:3.1mmol/L,BE:-24.7mmol/L，AG:34.6mmol/L • BUN :15.9mmol/L,Cr:147mmol/L • K+:8mmol/L,Na+:118mmol/L,Cl-:80mmol/L,Glu:33mmol/L • urinalysis:ketone:3+,gravity:1.024,glu:4+
deficiency, are partially oxidized and converted in the liver to acetoacetate
and β-hydroxybutyrate.
• This alteration of liver metabolism to oxidize FFAs to ketones rather than
Diabetic ketoacidosis (DKA)
emergency department of shengjing hospital zhang hong lei
case
• Mr wang，M，52 years old • chief complaint：polydipsia, polyuria, weakness for1week，vomiting for 10
Grownth
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hormone
Pathophysiology
Pathophysiology
•
Insulin deficiency and glucagon elevation results in
hyperglycemia,which in turn cause glycosuria
• Glucose in the renal tubules draws water, sodium, potassium,