User:IsraaBaker/sandbox

DKA is one of the life-threatening severe complications of diabetes that demands immediate attention and intervention. It is considered a medical emergency and can affect both patients with T1D (type 1 diabetes) and T2D (type 2 diabetes), but it is more common in T1D. (1) DKA results from significantly low insulin levels due to various factors including undiagnosed diabetes (people who did not know they have diabetes), missed or delayed doses, insufficient insulin administration, or undergoing physiological stress (e.g. infection, surgery, Stroke, or trauma). (1) (2) (4)

Due to insulin absence, it simply triggers the release of counter-regulatory hormones resulting in serious health complications. This release prompts excessive free fatty acids (FFAs) production as a result of the adipose tissue exhibiting heightened activity of hormone-sensitive lipase. Subsequently, the liver turns fatty acid to ketone bodies for fuel, a process known as ketosis, which causes Ketonemia (high ketone level in the blood) that decreases the blood's pH, leading to DKA. While periodic ketosis is normal, but can become a serious problem if sustained. These hormones can also induce hyperglycemia (high blood glucose) by stimulating gluconeogenesis thereby increasing the renal glucose output. In addition to the endogenous renal glucose produced by the kidneys. The condition of high circulating concentrations of ketone bodies and hyperglycemia leads to osmotic diuresis, characterized by the excessive presence of glucose and ketones in the urine. Consequently, osmotic diuresis causes dehydration and electrolyte loss. (2) (3) (4) (7) (8) (9) Symptoms of DKA can be noticed within a few hours, like polyuria (excessive urine production), polydipsia (excessive thirst), Weight loss, weakness, nausea, vomiting, and deep rapid breathing (Kussmaul respiration). Moreover, abdominal pain is common and may be severe. (2) (10) The level of consciousness is typically normal until late in the process, when lethargy may progress to coma. (3) (8) Ketoacidosis can easily become severe enough to cause hypotension, shock, and death. (3) The DKA is diagnosed by the urine analysis which will reveal significant levels of ketone bodies (which have exceeded their renal threshold blood levels to appear in the urine, often before other overt symptoms). And also venous blood investigation for electrolytes, glucose, and acid-base status. (10) (3) The expected result of the treatment tackles the deeper causes; which are dehydration, acidosis, and hyperglycemia, and initiates a reversal of the ketosis process. (4) While replacing fluid and electrolyte loss, insulin, and acid-placed balance are the aim of this treatment. (3) proper treatment usually results in full recovery, though death can result from inadequate or delayed treatment, or from complications (e.g., brain oedema). (8)

Preventing DKA is attainable by following some precautions. Starting with regular monitoring of blood glucose levels. In addition to measuring blood or urine ketone concentrations twice a day and more. In case there are ketones, insulin doses should be increased. Patients are also advised to focus on dehydration and go to the hospital in case of frequent vomiting. It's essential to emphasize that insulin should never be discontinued, even if there is no intake of food or fluids. Patients' education and awareness of managing a sick day is a key element, as recognizing symptoms, and knowing when to contact a healthcare provider. This education significantly contributes to reducing the occurrence of DKA. (3) (8) (9)

1- S T E P - U P T O MEDICINE 2- baby essentials 3- Hyperglycemic Crises: Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State 4-Diabetic Ketoacidosis - Review Article 5- Comprehensive review of diabetic ketoacidosis: an update 6- Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome: review of acute decompensated diabetes in adult patients 7- Diabetic Ketoacidosis: A Review and Update 8- Diabetic ketoacidosis\ \\Ketan K. Dhatariya 9-Diabetic emergencies — ketoacidosis, hyperglycaemic hyperosmolar state and hypoglycaemia 10-Davidson's Principles and Practice of Medicine - 24th

Hyperglycaemic hyperosmolar state (HHS) is an acute complication sharing many symptoms with DKA, but an entirely different origin and different treatment,(1) Oppositely, the prevalence of HHs is common in individuals with T2D. Furthermore, it showcases approximately ten times greater mortality rate than the observed in DKA.(4)

Both DKA and HHS occur when insulin becomes less effective, either due to a shortage of insulin secretion ( as in DKA), or lack of proper insulin action (as in HHS). (5) For a person with very high blood glucose levels(usually considered to be above 30 mmol/L (600 mg/dL), (1) that will result in osmotic diuresis, water is osmotically drawn out of cells into the blood and the kidneys eventually begin to dump glucose into the urine. This results in a loss of water (which contains electrolytes and glucose) that will increase blood osmolarity. (5) (3)(6) If the fluid is not replaced, by mouth or intravenously, will ultimately result in dehydration (which in HHS typically becomes worse than DKA). (6) Also causes electrolyte imbalances which are always dangerous. (5) And a decline in consciousness levels is primarily attributed to an increase in plasma osmolality.,(2) lethargy may ultimately progress to a coma which is more common in T2D than T1D.(6) (3) HHS, unlike DKA, does not result in significant ketosis and acidosis, or there may be only a very minimal. This is because the presence of a small quantity of insulin suppresses the release of counterregulatory hormones and limits the production of ketones. (2)(3)

Multiple factors can trigger HHS, including infection, cerebrovascular events, myocardial infarction, and trauma),(1) (4) (7) as well as infections in the respiratory, digestive, and urinary systems. (4) (7) Rising obesity rates and the greater consumption of high-carbohydrate beverages have both played a role in the increased incidence of HHS.. (6) Moreover, certain medications prescribed for different conditions have the potential to cause HHS.(7) (1) As with DKA, urgent medical treatment is necessary, commonly beginning with fluid volume replacement. (5) On the whole, HHS is a medical emergency marked with hyperglycemia, hyperosmolarity, dehydration, and mild or no ketosis(3) (1).

1-Davidson's Principles and Practice of Medicine - 24th 2-_Baby_ Essentials of Kumar & Clark’s Clinical Medicine - 6th Edition 3-Step-up-to-medicine-Edited 4-Hyperosmolar Hyperglycemic State: A Historic Review of the Clinical Presentation, Diagnosis, and Treatment 5-Hyperglycemic Crises: Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State 6-Hyperosmolar Hyperglycemic Syndrome 7-Diabetic emergencies — ketoacidosis, hyperglycaemic hyperosmolar state and hypoglycaemia