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==Natural History==
==Natural History==
If left untreated, diabetic ketoacidosis may progress to multi-organ failure and death. The ketone bodies (β-hydroxybutyrate and acetoacetate) and ketoacids stimulate chemoreceptors in the CNS, resulting in hyperventilation. Clinically, this response is observed as Kussmaul respirations. Early in the course of the ketoacidotic process, hyperventilation results in a reduction of pCO2. The metabolic acidosis is compensated, and pH may be normal or only slightly reduced (e.g., in mild or moderate DKA). As DKA progresses into the severe stages, more significant acidosis occurs and pH falls. Any compromise in the ability of the lungs to compensate for the acidosis such as might occur in pulmonary disease (pneumonia, asthma, or adult respiratory distress syndrome) or CNS depression (e.g., cerebral edema), would be expected to worsen the acidosis and the prognosis. Other intercurrent conditions, such as sepsis or renal insufficiency, would also be expected to worsen the prognosis. Although acidosis impairs myocardial contractility, heart failure and cardiogenic shock are rare in children with DKA. Heart failure, myocardial infarction, and arrhythmias during DKA are not uncommon in adults. In children, hypotension or shock during DKA is nearly always the result of hypovolemia or cerebral edema.
* If left untreated, diabetic ketoacidosis may progress to multi-organ failure and death.  
*[[Vomiting]] or [[nausea]]
* Early in the course of the ketoacidotic process, hyperventilation results in a decrease in pCO2. The metabolic acidosis is compensated, and pH may be normal or only slightly reduced (e.g., in mild or moderate DKA).  
*[[Shortness of breath]] or fruity breath 
* As DKA progresses into the severe stage, more significant acidosis occurs and pH falls.  
*Decreased [[consciousness]] or mental [[stupor]]
* If compensatory hyperventilation does not occur for the acidosis, such as, in pulmonary disease (pneumonia, asthma, or adult respiratory distress syndrome) or CNS depression (e.g., cerebral edema), the acidosis becomes more severe and results in a poor prognosis.  
* Although acidosis impairs myocardial contractility, heart failure and cardiogenic shock are rare in children with DKA.
* Hypotension or shock during DKA is nearly always the result of hypovolemia or cerebral edema in children
* Heart failure, myocardial infarction, and arrhythmias during DKA are seen commonly in untreated diabetic ketoacidosis. In children,


==Complications==
==Complications==
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==Prognosis==
==Prognosis==
Prognosis of diabetic ketoacidosis depends on:
 
*Whether the patient is diagnised or treated in time
=== Signs of poor prognosis ===
*The age of the patient: Older people have worse outcomes than the young.
* The following are the signs of poor prognosis in diabetic ketoacidosis at the time of diagnosis:
*Whether [[complication]]s, such as [[heart attack]], [[renal failure]] and [[hypokalemia]] occur.
** Hypothermia
** Coma
** Oliguria
** Extremes of age (young and elderly)
** Intercurrent comorbidity, for example, myocardial infaction, sepsis
** Over the last 3 decades, mortality rates from DKA have significantly decreased in developed countries, from 7960 per 100,00 indivuals to 670 per 100,00 individuals in


==References==
==References==

Revision as of 19:50, 10 August 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Overview

Natural History

  • If left untreated, diabetic ketoacidosis may progress to multi-organ failure and death.
  • Early in the course of the ketoacidotic process, hyperventilation results in a decrease in pCO2. The metabolic acidosis is compensated, and pH may be normal or only slightly reduced (e.g., in mild or moderate DKA).
  • As DKA progresses into the severe stage, more significant acidosis occurs and pH falls.
  • If compensatory hyperventilation does not occur for the acidosis, such as, in pulmonary disease (pneumonia, asthma, or adult respiratory distress syndrome) or CNS depression (e.g., cerebral edema), the acidosis becomes more severe and results in a poor prognosis.
  • Although acidosis impairs myocardial contractility, heart failure and cardiogenic shock are rare in children with DKA.
  • Hypotension or shock during DKA is nearly always the result of hypovolemia or cerebral edema in children
  • Heart failure, myocardial infarction, and arrhythmias during DKA are seen commonly in untreated diabetic ketoacidosis. In children,

Complications

People with diabetic ketoacidosis need close and frequent monitoring for complications. Surprisingly, the most common complications of DKA are related to the treatment:

Prognosis

Signs of poor prognosis

  • The following are the signs of poor prognosis in diabetic ketoacidosis at the time of diagnosis:
    • Hypothermia
    • Coma
    • Oliguria
    • Extremes of age (young and elderly)
    • Intercurrent comorbidity, for example, myocardial infaction, sepsis
    • Over the last 3 decades, mortality rates from DKA have significantly decreased in developed countries, from 7960 per 100,00 indivuals to 670 per 100,00 individuals in

References

  1. ↑ "Diabetic ketoacidosis". Diabetic ketoacidosis. Mayo Foundation for Medical Education and Research. 2006. Retrieved 2007-06-15. Text " By Mayo Clinic Staff " ignored (help)
  2. ↑ "Diabetic Coma > Diabetic ketoacidosis". Diabetic ketoacidosis. Armenian Medical Network. 2006. Retrieved 2007-06-15. Text " Umesh Masharani, MB, BS, MRCP " ignored (help)
  3. ↑ "Diabetic ketoacidosis complications". Diabetic ketoacidosis. The Diabetes Monitor. 2007. Retrieved 2007-06-15.

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