Symptoms Of Diabetic Ketoacidosis Research Articles

The Power of Linking Organ Systems

Understanding the body’s homeostasis through interactions among the eleven organ systems is an essential foundation for pre-professional undergraduate students studying human anatomy and physiology. This knowledge enables students to understand the pathophysiology of various disease states that result from non homeostatic conditions. We created an organ systems-based applied learning module containing the signs and symptoms of diabetic ketoacidosis (DKA), which can assist in increasing student engagement while making connections between normal conditions and disease states. The purpose of this module was to encourage students to use critical thinking skills and apply what they have learned in the classroom to real-world situations. Anatomy and Physiology II students at Gordon State College first learned about four major organ systems: endocrine, cardiovascular, respiratory, and urinary. Students completed each lesson and the corresponding assignment containing the basic functions of each organ system. Students then identified the organ systems’ physiological contributions to the signs and symptoms of DKA, such as hyperglycemia, ketoacidosis, ketonuria, hypokalemia, and osmotic diuresis. At the end of the semester, the students presented posters summarizing their overall understanding of the eleven organ systems’ involvement with the signs and symptoms of DKA. This learning module with the DKA poster project offered an innovative way for students to apply their classroom learning to real-world situations relevant to their potential future careers.

Signs and symptoms in the diagnosis of type 1 diabetes mellitus and interventions for the management of diabetic ketoacidosis: scoping review

Objective: To identify the most prevalent signs and symptoms in the diagnosis of Type 1 Diabetes Mellitus (DM1) in children and adolescents, as well as the signs and symptoms of Diabetic Ketoacidosis (DKA), its complications, and the nursing and medical interventions indicated for its management. Method: This is a scoping review, carried out in the LILACS, PUBMED, SCOPUS, LIVIVO, and Embase databases, with additional search in gray literature. The data were analyzed qualitatively. Results: We found 840 studies in the search, but only 10 studies met the eligibility criteria. The most frequent signs and symptoms in the diagnosis of DM1 were polydipsia (83%), polyuria (78%), and weight loss (56%). DKA symptoms were variable. The main complications of DKA were cerebral edema and death and transfer to the pediatric intensive care unit and continuous infusion of intravenous insulin were the most recommended interventions. Conclusion: Early recognition of the signs and symptoms of DM1 plays an important role in patient management, leading to rapid initiation of treatment and relevant interventions, thus preventing the occurrence of complications.

Hyperglycemic Crisis: Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State

The two most severe metabolic consequences of diabetes mellitus (DM) are diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemia state (HHS). Type 1 and type 2 diabetics are both susceptible to these illnesses. Hyperglycemia, ketone body production, and metabolic acidosis are symptoms of DKA. Hyperosmolality, high blood glucose increase, and little to no ketosis are signs of HHS. Despite significant advancements, it has been difficult to come to a consensus on the diagnostic criteria and course of therapy for both disorders. Another difficulty is that there is a large overlap between these two extremities of the hyperglycemia crisis continuum. A thorough biochemical and clinical patient evaluation, along with prompt diagnosis and therapy, has long been recognized as being essential for symptom relief. Intravenous insulin, fluid replacement, and concurrent management of the triggering causes all form the cornerstones of therapy. Large-scale research that contributes to the definition of how hyperglycemic crises should be handled is lacking globally. A thorough analysis of the pathogenesis, diagnosis, and treatment of DKA and HHS will be provided in this article.

Diabetic ketoacidosis and cognitive impairment in children and adolescents

The aim of the literature review was to highlight modern scientific sources on the formation and clinical manifestations of cognitive impairment in children and adolescents with type 1 diabetes mellitus (DM) after diabetic ketoacidosis (DKA). Type 1 DM is one of the most prevalent endocrine disorders in childhood and adolescence. DKA is the most common acute complication of type 1 DM that may cause cognitive impairment. Cerebral edema is the main cause of cerebral vascular insufficiency in patients with DKA. However, the mechanisms underlying the development of cognitive dysfunction in DKA have not been fully elucidated.The leading hypotheses include development of neuroinflammation, oxidative stress, disruption of neurogenesis, and neurodegeneration. Hypoxic – ischemic injury and changes in the brain neuroanatomy may also cause cognitive dysfunction. Disruption of some brain structures has been reported after DKA episodes, primarily affecting the white matter. Clinical studies in the pediatric population support the presence of a correlation between the severity and frequency of DKA and the severity of cognitive impairment. Cognitive dysfunction in children and adolescents after a DKA episode can manifest through decreased attention, impaired memory and executive function, and reduced IQ. The earliest possible diagnosis of cognitive impairment in pediatric patients with symptoms of DKA in the context of type 1 DM can improve the treatment prognosis for this endocrinopathy.

Incidence and predictors of mortality in children with diabetic ketoacidosis in the comprehensive specialized referral hospitals of West Amhara Region, Northwest Ethiopia: a retrospective follow-up study.

Diabetic ketoacidosis is one of the major life-threatening conditions associated with acute metabolic complications. It remains a major public health problem in developing countries such as Ethiopia. To assess the incidence and prediction of mortality in children with diabetic ketoacidosis in West Amhara Region Comprehensive Specialized Referral Hospitals, Northwest Ethiopia, in 2022. An institution-based retrospective follow-up study was conducted among 423 study participants with a confirmed diagnosis of diabetic ketoacidosis from 01/01/2017 to 31/12/2021. Data were entered, coded, cleaned, and checked using Epi-Data version 4.6 and exported to Stata version 14 for data analysis. A total of 401 child records were included in the final analysis and were followed for 3781 days during the study period. The overall mortality of children with diabetic ketoacidosis was 10.6 per 1000 person-days observed (95% CI: 7.8-14.4) during the entire follow-up period. Hypoglycemia (AHR=4.6; 95% CI: 2.13-10.1), rural residence (AHR=2.9; 95% CI=1.01-8.11), age younger than five (AHR=4.4; 95% CI=1.4-13.7) or between five and 10 (AHR=3.1; 95% CI=1.1-8.8), and female gender (AHR=2.6; 95% CI=1.1-5.8) were significant predictors of mortality. The incidence rate of mortality in children with diabetic ketoacidosis was relatively high. Age, rural residence, female gender, and hypoglycemia were significantly predictive of mortality. Community education or mass campaigns about the signs and symptoms of diabetic ketoacidosis may reduce the mortality rate in children.

A PROSPECTIVE STUDY OF RISK FACTORS AND CLINICAL PROFILES IN DIABETIC KETOACIDOSIS PATIENTS

BACKGROUND: Hyperglycemia, hyperosmolarity, accelerated lipolysis, ketonemia, and metabolic acidosis are all symptoms of diabetic ketoacidosis (DKA). It is characterised by absolute or relative insulin insufficiency, with a 5- percent overall mortality rate in hospitals.AIMS AND OBJECTIVES:A prospective study in a tertiary care hospital to identify risk variables and clinical characteristics in diabetic ketoacidosis (DKA).MATERIALS AND METHODS: The study includes 50 patients with diabetic ketoacidosis who match the inclusion criteria for diabetic ketoacidosis. According to the inclusion criteria,diabetic ketoacidosis was diagnosed. Hyperglycemia >250 mg/dl, acidosis (blood pH 7.3),and ketones in urine.RESULTS:A total of 50 patients were enrolled in the trial.A total of 50 patients were tested, with 21 (42%) having type I diabetes and 29 (58%) having type II diabetes.There were 23 (46 percent) males and 27 (54 percent) females among the 50 patients.The majority of the patients (12%) were between the ages of 30 and 60 years old. Nausea and vomiting were the most common presenting symptoms in 34 of the patients (68 percent). Drug noncompliance was the most common precipitating factor, accounting for 16 (32 percent), followed by urinary tract infections (12 (24 percent), and random blood sugar levels of more than 300 mg/dL in 48 (96 percent) of patients at the time of presentation. CONCLUSION: Diabetic ketoacidosis (DKA) was common in people with type 2 diabetes (58 percent ). DKA was more prevalent in persons between the ages of 30-40 (24%) and 50-60 (24%) years old. The most prevalent presenting complaints were nausea/vomiting (68 percent) and shortness of breath (66 percent). Drug noncompliance (32 percent) and infection are the most common triggering causes. At the time of presentation, the majority of patients have blood sugar levels of 200-300 mg/dL (30%).To avert issues,extensive patient education should be offered.

Diabetic Ketoasidosis

Diabetic ketoacidosis (DKA) is one of the acute complications for diabetics that usually occurs in type 1 DM, but it is possible in type 2 DM. DKA is caused by a decrease in effective insulin circulation associated with an increase in counter-regulatory hormones. The incidence of DKA ranges from 0 to 56 per 1000 people each year. In Indonesia, it is known that 71% of pediatric patients have DKA as the initial clinical presentation of type-1 DM in 2017. To know more about diabetic ketoacidosis. Knowing the characteristics of patients with diabetic ketoacidosis. Know how to treat patients with diabetic ketoacidosis. This reserch use Literatur-review method. DKA is a complication of uncontrolled type 1 diabetes mellitus and has a high risk of being life-threatening. The incidence of DKA in Indonesia is not known for certain, but it is estimated at 76.9% based on data from Riskesdas in 2007. DKA occurs due to insulin deficiency which will result in increased lipolysis and usually occurs due to metabolic stress conditions. Symptoms of DKA are symptoms of hyperglycemia and classic symptoms of hyperglycemia. The key to the diagnosis of DKA is an increase in total circulating ketone bodies. The initial management of DKA is to monitor and secure the airway, breathing, circulation.

Clinico - Epidemiological Profile of Diabetic Ketoacidosis in Hospitalised Children at a Tertiary Health Care Centre

Introduction: Diabetic Ketoacidosis (DKA) presents with spectrum of clinical manifestations and awareness regarding this amongst physicians is crucial. The study aimed to chronicle the clinical profile of DKA in type 1 diabetes mellitus (T1DM) children. Methods: The study was conducted at a tertiary care hospital including patients with signs and symptoms of DKA with either debut or established T1DM (n = 38). Detailed clinical history, examination and laboratory investigations were carried out. Differences in frequency distribution concerning demographics and clinical data were analysed in R-studio software (v.1.2.5001). Results: Kussmaul breathing (49.97%) was the commonest presentation. Infection (39.46%) and poor compliance due to inadvertent omission of insulin therapy (50%) were the commonest precipitating factors. Mild, moderate and severe dehydration was present in 44.74%, 39.47% and 15.79% respectively. Forty-five percent patients had moderate while 34.21% and 21.05% had mild and severe DKA respectively. Seventy-five percent and 52% patients were below 3rd percentile for height and weight respectively. High number of patients had past history of viral infections, were diagnosed in winter, belonged to 2nd or 3rd birth order and from lower middle class. Patients with poor compliance to insulin belonged to lower middle (40%), upper lower (53.33%) and lower class (6.67%). Conclusions: DKA can be diagnosed early by identifying dehydration, Kussmaul breathing, polyuria and altered sensorium. Infection and poor compliance due to omission of insulin therapy were the commonest and preventable precipitating factor for DKA. Poor compliance to insulin can be attributed to lower socioeconomic class. Awareness among physicians concerning clinical profile of DKA is crucial.

English

BACKGROUND Diabetic ketoacidosis (DKA) is a life-threatening condition of diabetes that is characterized by hyperglycaemia, ketoacidosis, and ketonuria. It happens when glucose's ability to enter cells for use as metabolic fuel is blocked by absolute or relative insulin deficiency. This causes liver to divide fat into ketones as a source of fuel. The purpose of the study was to assess the knowledge regarding prevention of signs and symptoms of diabetic ketoacidosis among diabetes patients in selected hospitals of Wardha district. METHODS A descriptive study was undertaken among 60 purposively selected patients of diabetes with diabetic ketoacidosis in Wardha district. Data was collected by using structured knowledge questionnaire during the month of May 2020. RESULTS The level of awareness among diabetes patients on how to avoid diabetic ketoacidosis was measured. The findings of study show that 49 (80 %) people had poor level of knowledge score and 11 (20 %) people had average level of knowledge score. Mean score was 4.38 ± 2.48 with mean percentage 24.35 ± 13.80. The association of knowledge score with educational status of diabetes patients from selected hospital. The tabulated ‘F’ values were 2.76 (df = 3, 56) which is much less than the calculated ‘F’ i.e., 8.73 at 5 % level of significance. Also, the calculated ‘P’=0.0001 which was much less than the acceptable level of significance i.e., ‘P’=0.05. Hence, it is interpreted that educational status of diabetes patients is statistically associated with their knowledge score. CONCLUSIONS Most patients with diabetes are poorly aware of the preventive measures of diabetic ketoacidosis. This study revealed several preventive gaps relating to an appropriate prevention strategy and acute diabetes complications. This research concluded that most patients with diabetes had insufficient knowledge of the signs and symptoms of diabetic ketoacidosis and its management. KEY WORDS Knowledge, Prevention, Sign, Symptoms, Diabetic Ketoacidosis, Diabetes Patients

Knowledge and Awareness of Caregivers about Diabetic Ketoacidosis among Type-1 Diabetic Children and Their Action and Response in Riyadh City

Objectives: Diabetic ketoacidosis (DKA) is a life-threatening metabolic disorder in which its complications can be avoidable. The purpose of this study is to identify and measure the level of knowledge and awareness of caregivers about the symptoms of DKA in children in Riyadh city. Setting and Participants: This cross-sectional study design was conducted in Riyadh city in Saudi Arabia. A sample size of at least 412 was required. The total number of respondents that were included in the analysis was 414. The method of collection of data done by data collectors. Results: Two hundred and sixty-eight (64.7%) of the participants reported that they know about DKA, yet it was still a concerning figure since 35.3% did not know about it, which necessitating diabetes self-management education at national levels in Saudi Arabia. Conclusion: This study showed that the majority of type-1 diabetic caregivers had knowledge and awareness regarding DKA in Riyadh, Saudi Arabia. Further studies would assess more factors to enhance the level of knowledge and awareness, and increase the effectiveness toward the right action and response regarding DKA.

DIABETIC KETOACIDOSIS WITH LOWER-THAN-ANTICIPATED GLUCOSE LEVELS WITH SGLT-2 INHIBITOR CANAGLIFLOZIN: A CASE REPORT AND REVIEW OF THE LITERATURE.

We describe a case report of a patient who presented with euglycemic diabetic ketoacidosis (euDKA), six days after starting treatment with sodium-glucose cotransporter-2 (SGLT2) inhibitor, Canagliflozin. ‘Euglycemic diabetic ketoacidosis’ or ‘DKA with lower-than-anticipated glucose levels’ (as recommended by AACE/ACE) is a rare, challenging and easy to miss the diagnosis A 41-year-old male with a history of type 2 Diabetes Mellitus presented with uncontrolled hyperglycemia. Canagliflozin (SGLT2 inhibitor) was added to his anti-diabetic regimen of Metformin and Sitagliptin. Six days later, he presented with symptoms of diabetic ketoacidosis with normal blood glucose of 131mg/dl. The patient was further investigated with arterial blood gas analysis and serum ketone studies, keeping in view of the potential of euglycemic diabetic ketoacidosis (euDKA) with SGLT2 inhibitor use. The clinical picture and lab values of the patient were consistent with diabetic ketoacidosis(DKA), although it is rare in type 2 DM. Blood glucose was in the normal range which could have delayed the diagnosis if the physician was not vigilant. If one had only focused on the blood glucose, then this potentially fatal condition could have been missed. However, when other causes of anion gap metabolic acidosis were excluded and the lab values of urine ketones, elevated beta-hydroxybutyrate, reduced bicarbonate, and normal lactate interpreted, it leads to the diagnosis of SGLT2 inhibitor-associated euglycemic DKA. We performed a literature review of this topic and discuss the history of euglycemic diabetic ketoacidosis, risk factors, pathophysiology, diagnosis, management, and prevention of SGLT2 inhibitor-induced euDKA.

SAT-LB112 An Unusual Case of Ipilimumab/Nivolumab Induced Fulminant Diabetic Ketoacidosis (DKA) in a Non Diabetic Patient - a Case Report

SAT-LB112 An Unusual Case of Ipilimumab/Nivolumab Induced Fulminant Diabetic Ketoacidosis (DKA) in a Non Diabetic Patient - a Case Report

2401-PUB: High Rates of Unrecognized Ketosis in Youth with T1D and Elevated A1c Levels

Youth with type 1 diabetes (T1D) who have A1c levels ≥ 9% have a 13-fold higher rate of diabetic ketoacidosis (DKA) than youth with A1c <7.5% and the rate of DKA is 2-fold higher with multiple daily injections (MDI) than with pump therapy. However, the frequency of mild to moderate ketosis (the gateway to DKA in these high-risk patients) is largely unknown and such knowledge is essential to evaluate strategies aimed at DKA prevention. Methods: Youth ages 8-18 years with uncontrolled T1D (A1c> 8.5%) on MDI treatment were enrolled in the study. Blood glucose (BG) and blood β-hydroxybutyrate (BHB) levels were measured by school personnel in the AM on arrival to school. Results: 14 patients (age 15 ± 2.3 years) enrolled in the study had A1c 10.7 ± 1.5% (range 8.8 - 14.0%). BHB or urine ketones were measured on 125 school days; ketone levels were small (0.6-0.9 mmol/L) on 6.4% of days (mean BHB 0.7+0.1 mmol/L) and moderate/large (>0.9 mmol/L) on 10.4% of days (mean BHB 2.1+1.4 mmol/L) (Figure). BG ranged between 147 to >600 mg/dL on days with elevated BHB levels; all were without other signs or symptoms of DKA. Conclusions: Unrecognized mild to moderate ketosis during regular school attendance is common in youth with uncontrolled T1D on MDI therapy. Novel strategies, such as having school personnel supervise injections of long-acting basal insulin, are needed to support reliable insulin dosing to prevent ketosis in youth with uncontrolled T1D at risk for DKA Disclosure L.M. Nally: None. S. Elahi: None. M.A. Van Name: Research Support; Self; Novo Nordisk Inc. A. Steffen: None. E.M. Tichy: None. A.D. Urban: None. K. Weyman: None. W.V. Tamborlane: Consultant; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Medtronic MiniMed, Inc., Novo Nordisk Inc., Sanofi, Takeda Pharmaceutical Company Limited. Funding Novo Nordisk

Annals for Educators - 5 February 2019.

Annals for Educators - 5 February 2019.

An Effective Diabetic Ketoacidosis Prevention Intervention in Children With Type 1 Diabetes.

The objective of this study was to evaluate the effectiveness of a brief, office-based educational intervention to increase parent or patient recognition of the early warning signs and symptoms of diabetic ketoacidosis (DKA). Forty-two patients aged > 13 years and 34 parents of children aged ≤ 13 years were given a pretest questionnaire about their knowledge of signs and symptoms of DKA and sick day management practices. They received a brief refresher course on sick day management specific to their treatment modality (pump vs. injection) and were given a take-home flow sheet of guidelines for diabetes sick day management. Subjects were retested with the same knowledge questionnaire after 6 to 12 months. Patients or parents scored higher on the posttest than the pretest and called the emergency line for assistance more frequently (p = .032) following the intervention. Emergency department visits were significantly reduced in adolescents (p = .024). A short educational intervention and printed management tool is effective in improving sick day and DKA knowledge and appears to be effective in reducing emergency department visits by increasing utilization of a diabetes emergency line for early outpatient intervention.

Clinical Characteristics of Diabetic Ketoacidosis in Children with Newly Diagnosed Type 1 Diabetes in Addis Ababa, Ethiopia: A Cross-Sectional Study.

BackgroundDiabetic ketoacidosis (DKA) is one of the most serious acute complications of type 1 diabetes (T1D) and the leading cause of morbidity and mortality in children with T1D. This study was aimed at assessing the prevalence and associated factors of DKA in children with newly diagnosed T1D in Addis Ababa.MethodsA hospital based cross-sectional study was conducted in selected hospitals in Addis Ababa. Children below the age of 12 years with DKA who were admitted to the pediatric ward in the selected hospitals between January 2009 and December 2014 and the residence of Addis Ababa were included. DKA was defined as children below the age of 12 years who have blood glucose level ≥250mg/dl, ketonuria, and ketonemia and diagnosed being T1D patient for the first time. Descriptive statistics was performed using frequency distribution, mean, median, tables, and graphs. Logistic regression analysis was used to identify independent factors associated with the prevalence of DKA in children with newly diagnosed T1D.ResultsOf 395 DKA patients who were hospitalized during the five-year period, 142(35.8%) presented with DKA at first diagnosis of diabetes. On the other hand 253 (64.2%) children with DKA had longstanding T1D. Independent factors associated with DKA include: Age category 2–4.49years, 7–9.49 years and ≥9.5years (Adjusted odd ratio (AOR) = 3.14[1.21,8.06]), 3.44(1.39,8.49) and 4.02(1.68,9.60), respectively); parents’ knowledge on the sign and symptoms of DKA (AOR = 0.51[0.27, 0.95]); sign and symptoms of DKA before the onset of DKA (AOR = 0.35[0.21, 0.59]) and infection prior to DKA onset (AOR = 3.45[1.97, 6.04]).ConclusionsThe overall proportion of children diagnosed with DKA and new onset of T1D in Addis Ababa was high. In particular, children between 9–12 years of age and children whose parents did not know the sign and symptoms of DKA had a high risk of DKA at primary diagnosis of T1D.

Alcohol Induced Diabetic Ketoacidosis Exacerbated by an Acute Respiratory Infection with Klebsiella pneumoniae

Ketoacidosis is a metabolic condition that occurs as a result of an insufficient amount of insulin. The lack of insulin results in an increased release of glucose from the liver and an excess of ketone bodies as a result of the breakdown of adipose tissue. This occurs when carbohydrates are unable to be properly processed for needed energy requirements during cellular metabolism. Ketoacidosis is commonly linked to diabetes mellitus. Diabetes mellitus is a condition where the body is unable to produce the proper amount of insulin or is unable to effectively respond to insulin stimulation. Excessive alcohol use can damage the pancreas, reducing insulin secretion. Other conditions such as pneumonia or urinary tract infections can trigger the release of counter-regulatory hormones that may contribute to the decrease in insulin's activity and secretion. Symptoms of diabetic ketoacidosis often include nausea and vomiting, increased thirst and urine production, hyperglycemia, abdominal pain, shortness of breath, confusion, headache, general weakness, fatigue and increased heart rate. If left untreated, diabetic ketoacidosis can lead to more serious complications including circulatory collapse, decreased blood potassium levels, infection and cerebral edema. The following case study presents a complex condition of ketoacidosis associated with a bacterial infection compounded by the patient's history of alcohol abuse.

Heartbreak to Happiness: Striving to Improve Outcomes for the Patient in Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is an acute, major, life-threatening complication of diabetes that warrants prompt recognition and a multidisciplinary approach to provide intensive management and monitoring of both mother and fetus. DKA is estimated to occur in 1 to 2% of pregnancies complicated by preexisting diabetes, with 10 to 30% of women having a serum glucose less than 250 mg/dl upon diagnosis, and it poses a significant risk for the fetus, with perinatal mortality rates reported between 9% and 35%. Factors that increase the risk of DKA in pregnant patients include stress, trauma, infection, poor patient compliance, insulin pump failure, accidental omission of insulin, and medications utilized in the obstetric setting. It is crucial that nurses are familiar with the clinical signs of DKA so that prompt and appropriate treatment can be initiated to optimize outcomes for both the pregnant woman and her fetus. To better understand the signs and symptoms of DKA, an outline of the multisystem effects of a patient in DKA will be provided.

Different characteristics of diabetic ketoacidosis between type 1 and type 2 diabetes patients in Malaysia

Background: Diabetic ketoacidosis (DKA) is increasing in patients with type 2 diabetes in Asian countries. However, there is little information regarding the frequency and characteristics of DKA for Malaysian population. Objective: To identify the different clinical and biochemical features of DKA between adult patients with type 1 and type 2 diabetes. Methods: A cross-sectional, retrospective study was performed at University Malaya Medical Centre (UMMC) between January 2000 and December 2005. All patients (aged >18 years) with type1 or type 2 diabetes were included in this study. Clinical and biochemical characteristics of DKA were studied. Precipitating factors for the development of DKA were also identified. Results: One hundred and twenty patients (61.9%) presented with DKA had type 2 diabetes. Both type 1 and type 2 patients had similar symptoms. Nausea (44.0%) and vomiting (66.4%) were most common symptoms of DKA. Infection (40.5%) was main precipitating factors of DKA. Blood pH level in previously-diagnosed type 1 diabetes patients was lower than that in previously-diagnosed type 2 diabetes (7.18±0.18 vs. 7.26±0.16, p<0.0001). Conclusion: A high proportion of DKA occurs in patients with type 2 diabetes. DKA developed severely in newly-diagnosed type 2 diabetes patients more than in previously-diagnosed type 2 diabetes patients.

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Ketoacidosis is a metabolic condition that occurs as a result of an insufficient amount of insulin. The lack of insulin results in an increased release of glucose from the liver and an excess of ketone bodies as a result of the breakdown of adipose tissue. This occurs when carbohydrates are unable to be properly processed for needed energy requirements during cellular metabolism. Ketoacidosis is commonly linked to diabetes mellitus. Diabetes mellitus is a condition where the body is unable to produce the proper amount of insulin or is unable to effectively respond to insulin stimulation. Excessive alcohol use can damage the pancreas, reducing insulin secretion. Other conditions such as pneumonia or urinary tract infections can trigger the release of counter-regulatory hormones that may contribute to the decrease in insulin9s activity and secretion. Symptoms of diabetic ketoacidosis often include nausea and vomiting, increased thirst and urine production, hyperglycemia, abdominal pain, shortness of breath, confusion, headache, general weakness, fatigue and increased heart rate. If left untreated, diabetic ketoacidosis can lead to more serious complications including circulatory collapse, decreased blood potassium levels, infection and cerebral edema. The following case study presents a complex condition of ketoacidosis associated with a bacterial infection compounded by the patient9s history of alcohol abuse. <b>ABBREVIATIONS:</b>CBC - complete blood count, CMP - complete metabolic panel, IV - intravenous fluid, mg/dL-milligrams per deciliter, mmol/L - millimoles per liter, mM - milli molar, IU/L - international unit per liter, g/dL - grams per deciliter, mmHg - millimeters of mercury, pCO₂ - partial pressure of carbon dioxide, CT - computed tomography, ICU - intensive care unit, μg/dL - micrograms per deciliter, ng/mL - nanograms per milliliter, U/L - units per liter, mOsm/kg - milliosmoles per kilogram, μmol/L - micromole per liter, pKa - acid disassociation constant