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KETOACIDOSIS AND HYPEROSMOLAR COMA Part 3Articles - Dr. Bernstein Shares His Insights KETOACIDOSIS AND HYPEROSMOLAR COMA Part 3Diabetes Solution Revised and Updated 2007
KETOACIDOSIS AND HYPEROSMOLAR COMA Part 3 result in the virtual absence of insulin-mediated glucose transport to the tissues of the body. In the absence of adequate insulin, the body metabolizes stored fats to produce the energy that tissues require to remain alive. A by-product of fat metabolism is the production of substances called ketones and ketoacids. One of the ketones, acetone, is familiar as the major component of nail polish remover. Ketones may be detected in the urine by using a dipstick such as Ketostix (see Chapter 3, “Your Diabetic Tool Kit”). Ketones may also be detected on the breath as the aroma of an organic solvent, which is why unconscious diabetics are often mistaken for passed-out drunks. Ketones and ketoacids are toxic in large amounts. More important, your kidneys will try to eliminate them with even more urine, thereby causing further dehydration. Some of the hallmarks of severe ketoacidosis are large amounts of ketones in the urine, extreme thirst, dry mouth, nausea, frequent urination, deep labored breathing, and high blood sugar (usually over 350 mg/dl). The other acute complication of high blood sugar and dehydration, hyperosmolar coma, is a potentially more severe condition, and occurs in people whose beta cells still make some insulin. (“Hyperosmolar” refers to high concentrations of glucose, sodium, and chloride in the blood due to inadequate water to dilute them.) Diabetics who develop this condition usually have some residual beta cell activity, making enough insulin to suppress the metabolism of fats, but not enough to prevent very high blood sugars. As a result, ketones may not appear in the urine or on the breath. Because this condition most commonly occurs in elderly people, who do not become very thirsty when dehydrated, the degree of dehydration is usually greater than in ketoacidosis. Early symptoms of a hyperosmolar state include somnolence and confusion. Extremely high blood sugars (as great as 1500 mg/dl) have been reported in cases of hyperosmolar coma. Fluid deficit may become so severe that the brain becomes dehydrated. Loss of consciousness and death can occur in both the hyperosmolar state and in severe DKA. The treatment for DKA and hyperosmolar coma includes fluid replacement and insulin. Fluid replacement alone can have a great effect upon blood sugar because it both dilutes the glucose level in the blood and permits the kidneys to eliminate excess glucose. Fluid also helps the kidneys eliminate ketones in DKA. Our interest here, though, is not in treating these conditions—this must be done by a physician or in a hospital—but in preventing them. Next Feature: Diabetes and Dehydration: Vomiting, Nausea, and Diarrhea – Adjusting Your Medications (Part 4) Last Features: Would you like to ask Dr. Bernstein a question?? Next FREE LIVE WEBCAST: Wednesday, January 16, 2007, we wll be having another live webcast and teleconference call with Dr. Richard K. Bernstein, who will answer questions from medical professionals and patients and it is free. Just go to www.diabetes911.net and register and ask a question if you like! To listen to the last 10 webcasts go to www.thebernsteinconnection.com
Also available a 5CD-6hour education series by Dr. Richard K. Bernstein: ORDER NOW!! www.diabetes911.net ALSO CHECK OUT Dr. Bernstein’s new site with all of his videos features and teleconference calls.
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Chapter 21
We would like to thank the publisher Little Brown and Company and Dr. Richard K. Bernstein, for allowing us to provide excerpts from Diabetes Solution 2007 Edition
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