Ketoacidosis

In the Ketoacidosis it is a variant of metabolic acidosis. It is particularly evident in the context of diabetes mellitus, when there is a total insulin deficiency.

What is ketoacidosis?

Typical signs of diabetic ketoacidosis include high blood sugar levels. As a result, the affected people suffer from fatigue, frequent urination, loss of appetite and thirst.
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The Ketoacidosis is a form of metabolic acidosis. In most cases, it occurs in type 1 diabetes mellitus. There is an absolute lack of insulin and there is a serious metabolic imbalance.

The typical characteristics of diabetic ketoacidosis (hyperacidity) include a high concentration of ketone bodies in the blood and increased blood sugar levels. Since ketoacidosis is an emergency, intensive medical therapy must be initiated immediately.

causes

As a rule, ketoacidosis forms an overacidification of the metabolism (acidosis) due to ketone bodies such as acetone. The metabolic imbalance is caused by the accumulation of organic acids such as ß-hydroxybutyric acid and acetoacetic acid in the blood. This will reduce its pH. It is almost always diabetic ketoacidosis, the cause of which is a prolonged lack of insulin.

The lack of insulin means that the body's cells are no longer able to extract glucose from the blood. It is only insulin that enables the Glut 4 transporter to be shifted into the cell membranes. In order to be able to take up glucose in a cell, however, this transporter must be present. In the further course of the process, the body's cells have insufficient energy balance.

The cells indicate the lack of energy to the brain. This leads to the release of adrenaline and noradrenaline as well as other insulin antagonists. This results in increased fat breakdown in the fatty tissues.The liver converts the fat that is released into ketone bodies and releases them into the blood.

The lack of insulin in turn results in increased fat breakdown in the liver, which leads to the formation of the acetyl coenzyme acetyl-CoA. From this then acetoacetate emerges. It is a salt of acetoacetic acid. The acetoacetate acts as an energy supplier within the tissue in the context of hunger metabolism.

In most cases, ketoacidosis is caused by the catabolic metabolic situation due to an insulin deficiency. Organic acids accumulate in the blood. Another typical trigger is a pronounced increase in ß-hydroxybutyric acid in the blood due to heavy alcohol consumption.

Doctors then speak of alcoholic ketoacidosis. Gluconeogenesis is inhibited by the alcohol. The same applies to the oxidation of free fatty acids within the liver. Other possible causes of ketoacidosis are the SCOT syndrome, in which there is a congenital succinyl-CoA-acetoacetate transferase deficiency, as well as various hereditary diseases.

Symptoms, ailments & signs

Typical signs of diabetic ketoacidosis include high blood sugar levels. As a result, the affected people suffer from fatigue, frequent urination, loss of appetite and thirst. In addition, the symptoms of hyperacidity show up.

These primarily include a smell of acetone in the air you breathe, deep breathing, also known as Kussmaul breathing, stomach pain, nausea and vomiting. There are also changes in consciousness, loss of consciousness, or even a diabetic coma. Furthermore, the body threatens to dehydrate.

If no medical treatment is provided, the patient can die. People who suffer from type 1 diabetes mellitus are particularly at risk for ketoacidosis. If, for example, an insulin injection is forgotten, this quickly results in a lack of insulin, which is noticeable through symptoms. There is also an increased risk of infections associated with a fever. If the metabolism collapses, there is a risk of a coma and failure of the circulatory system.

Diagnosis & course of disease

Since ketoacidosis is a medical emergency, the patient needs immediate medical attention and hospitalization. This is where the doctor's diagnosis takes place. This measures the blood sugar level and the ketone bodies in the urine. A blood sample is also taken from the wrist to check the pH and blood gases.

It also measures salts in the blood such as sodium or potassium and looks for signs of infection. In the worst case scenario, ketoacidosis can be fatal. However, patient recovery is possible if the doctor recognizes the symptoms in a timely manner. Without proper treatment, permanent damage to the brain, heart, and kidneys is possible.

Complications

Ketoacidosis usually results in a very severe insulin deficiency. This can have a very negative effect on the life of the person concerned and usually leads to serious complaints and complications. Most of those affected suffer from frequent urination, tiredness and fatigue.

In most cases, the patient's resilience also decreases enormously. The loss of appetite can lead to underweight and deficiency symptoms. It is not uncommon for those affected to suffer from abdominal pain and nausea and have to vomit frequently. The everyday life of the person affected is severely restricted by ketoacidosis. In the worst case scenario, it can lead to a loss of consciousness or a coma.

The affected person suffers from a fever and a weakened immune system. This can lead to inflammations and infections all over the body. The person affected can also collapse and injure themselves in the event of a fall. Ketoacidosis is usually treated with medication. Complications arise when treatment is not started on time. As a rule, life expectancy is not reduced with this disease.

When should you go to the doctor?

Diabetes patients should consult a doctor if there are signs of ketoacidosis. Symptoms such as loss of appetite and thirst, frequent urination and fatigue always need to be clarified by a doctor. Anyone who notices signs such as stomach pain, bad breath, or changes in consciousness should consult a doctor. If a severe fever occurs at the same time, an immediate doctor's visit is indicated. Ketoacidosis can be treated with medication if it is detected early enough. Therefore, consult a doctor at the first signs of metabolic acidosis.

People who suffer from an infection or type 1 diabetes mellitus are particularly prone to developing ketoacidosis. Anyone who belongs to these risk groups should have the symptoms clarified immediately by a doctor in order to avoid serious complications. If there are additional symptoms or the symptoms mentioned suddenly increase in intensity, medical advice is required. The right place to go is a general practitioner or an internist. In the event of a medical emergency, the sick person must be taken to a hospital immediately.

Treatment & Therapy

Treatment for ketoacidosis is in the hospital. Fighting the cause of the metabolic imbalance is in the foreground. The most important therapeutic measure is the intravenous administration of insulin and fluids. In addition, larger amounts of potassium must be administered promptly to counteract hypokalaemia. If there is a bacterial infection, antibiotics can also be useful.

As part of a ketoacidosis therapy, intensive medical or emergency medical treatment measures are also carried out to maintain vital functions. In addition, the patient must be monitored in the laboratory so that possible life-threatening changes are recognized in good time.

Rapid intervention is particularly necessary in the case of greater deviations from the potassium level or blood sugar levels. In the event of a greatly increased ketone body value, bicarbonate can also be administered if necessary.

Outlook & forecast

If there is no or inadequate treatment, ketoacidosis can be fatal. Statistically, 5 to 15% of patients die from a ketoacidotic coma. Life-threatening symptoms such as unconsciousness, dehydration and breathing difficulties can occur. If the therapy is inadequate, there is a risk of hypokalaemia. Ketoacidosis can also lead to lactate acidosis. Other common causes of death from ketoacidosis are cardiovascular failure and infections.

However, if ketoacidosis is detected in time so that treatment can be provided promptly, the outlook is good. A quick reaction time, ideally within hours of the onset of symptoms, reduces the risk of further deterioration. The temporary shortness of breath that can occur with ketoacidosis will completely resolve with successful treatment.

A rare risk that persists despite successful treatment is brain edema. In particular, the too rapid normalization of blood sugar is considered a risk factor. Neurological sequelae as a result are possible. This complication affects about 1% of patients with ketoacidosis. Children and young people are particularly at risk.

However, it should be noted that insulin treatment will still be required to prevent further ketoacidosis. Otherwise, the underlying disease can lead to ketoacidosis again. With the right follow-up treatment, the prospects for a full recovery are very good.

prevention

In order to avoid ketoacidosis in the first place, the blood sugar level of diabetics must be well adjusted. Type 1 diabetics are advised to always have an emergency dose of insulin with them. In the event of an infection, it can be useful to increase the insulin dose, which should be done in consultation with the doctor.

Aftercare

In the case of ketoacidosis, those affected usually have very few follow-up measures available. A diagnosis and subsequent treatment should be initiated at an early stage in order to prevent further symptoms and complications. As a rule, ketoacidosis cannot heal itself, so that the person affected with this disease is definitely dependent on treatment by a doctor.

Most of those affected have to take various drugs and antibiotics. The doctor's instructions should always be followed so that the symptoms can be completely alleviated. If anything is unclear or if you have any questions, you should always consult a doctor first in order to prevent the symptoms from worsening.

Various food supplements can also be taken to speed healing. When taking antibiotics, it should be noted that they should not be taken with alcohol. In most cases, no further follow-up measures are necessary after the treatment of ketoacidosis. The disease usually does not have a negative impact on the life expectancy of the person affected.

You can do that yourself

The most important self-measure is to prevent the development of diabetic ketoacidosis. To do this, the blood sugar must be correctly adjusted and regularly checked by a doctor. Even if you feel unwell, the values ​​should be measured; if necessary, a specialist should be consulted. Ketone bodies in the urine can be determined using special measuring strips from the pharmacy. If ketoacidosis has already developed, it must definitely be treated as an inpatient.

Various measures support the treatment and alleviate the individual symptoms. First of all, the body must be supplied with sufficient fluids and minerals. The diet should consist of salty foods, herbal teas and water in the acute phase of the illness. In order to stabilize blood sugar, sweet foods may be consumed in consultation with the doctor. The patient should also rest and take sick leave for a few days. If possible, strenuous physical activity should be avoided.

Light gymnastics exercises that get the circulation going and strengthen the immune system are permitted. Follow-up care also includes regular visits to the doctor. The health professional must ensure that blood sugar remains stable and that no further complications arise.