Ketoacidosis
The content of the article:
- Causes and risk factors
- Forms of the disease
- Stages
- Symptoms
- Features of ketoacidosis in children
- Diagnostics
- Treatment
- Possible complications and consequences
- Forecast
- Prevention
Ketoacidosis is a complex of symptoms that develop as a result of a shift in acid-base balance with the development of acidosis due to the accumulation of a high concentration of ketone bodies in the blood.
Most often, ketoacidosis develops as an emergency condition that complicates the course of diabetes mellitus, although sometimes it can also be observed in people who do not have this diagnosis.
Ketoacidosis is a medical emergency associated with the accumulation of ketone bodies in the blood
Normally, the conversion of glucose absorbed into the systemic circulation from the gastrointestinal tract is carried out in two directions. First, it is used to meet the energy needs of the body, being converted into energy during glycolysis. Secondly, it is stored in the form of glycogen or fats to cover possible energy costs if necessary. The utilization of glucose from the bloodstream into the cells of the body is provided by insulin, a hormone of the pancreas.
In diabetes mellitus, in conditions of insulin deficiency, a large amount of unused glucose is concentrated in the blood, which triggers a cascade of pathological reactions: the synthesis of ketone (acetone) bodies is activated, the volumes of their excretion decrease, alkaline buffer systems are depleted and acidification of the internal media of the body occurs - the actual ketoacidosis develops.
Causes and risk factors
Diabetes mellitus ketoacidosis can develop for several reasons:
- additionally associated (intercurrent) pathology that aggravated the course of the disease (acute inflammatory process, exacerbation of a chronic disease);
- incorrect treatment (excessively low doses of insulin, skipping or changing the dose on its own, canceling the hypoglycemic drug, malfunction of the insulin injection system or violation of the technique for its administration, expired drug shelf life);
- inadequate self-monitoring of blood glucose levels;
- diet errors;
- alcohol abuse;
- surgical interventions, injuries;
- acute violation of cerebral circulation;
- myocardial infarction;
- pregnancy;
- excessive psycho-emotional stress;
- systematic intake of insulin antagonist drugs (diuretics, glucocorticosteroids, β-blockers, oral contraceptives, etc.).
In addition to diabetes mellitus, which is the main cause of ketoacidosis, this pathological condition can develop against the background of chronic alcoholism or severe alcohol intoxication.
In pediatric practice, ketoacidosis occurs without concomitant diabetes mellitus, which has arisen for the following reasons:
- genetically determined predisposition;
- significant dietary errors (long "hungry" intervals, an abundance of saturated fats);
- thyrotoxicosis;
- neoplasms of the brain;
- leukemia;
- intoxication; etc.
Forms of the disease
Depending on the cause that caused the development of the pathological condition, ketoacidosis is divided into:
- diabetic;
- alcoholic;
- non-diabetic ketoacidosis (acetonemic vomiting, acetonemic syndrome, cyclic vomiting syndrome), which can be primary or secondary.
Stages
In accordance with the severity, there are three stages of ketoacidosis:
- Moderate ketoacidosis.
- Decompensated ketoacidosis, or precoma.
- Ketoacidotic coma.
Symptoms
Symptoms vary depending on the severity of the condition.
Moderate ketoacidosis is characterized by:
- weakness, increased fatigue;
- headache, feeling of "stale" head, episodes of dizziness;
- intense thirst;
- increased amount of urine discharge (polyuria);
- dry skin and mucous membranes;
- episodes of tachycardia;
- decreased appetite, nausea.
Weakness and fatigue is one of the symptoms of ketoacidosis
With an increase in the concentration of ketone bodies in the blood plasma, the clinical picture of decompensation of ketoacidosis will consist of symptoms of severe intoxication:
- lethargy, drowsiness, depression of consciousness;
- changing the cycle "sleep-wakefulness" in the form of shortening periods of wakefulness;
- slowing down reactions to stimuli;
- headache;
- lack of appetite, repeated vomiting;
- decreased muscle tone and tendon reflexes;
- dry skin and mucous membranes;
- cooling of the hands and feet;
- shortness of breath at rest and with light exertion;
- severe tachycardia, palpitations;
- slight hypotension;
- the tongue is coated with a thick brown coating;
- the smell of acetone in the exhaled air;
- tension and soreness in the epigastric and umbilical areas, right hypochondrium.
In the case of the development of ketoacidotic coma as an extreme degree of ketoacidosis, the following symptoms are noted:
- loss of consciousness;
- muscle atony;
- the skin is cold, cyanotic, with a marble pattern;
- cold clammy sweat;
- intense smell of acetone or baked apples from the mouth;
- noisy, deep, rapid breathing (abnormal breathing of Kussmaul);
- intense soreness in all parts of the abdomen (patients respond to palpation with a groan);
- tongue dry, coated with greenish-brown bloom.
Features of ketoacidosis in children
Children are characterized by ketoacidosis in the form of acetonemic vomiting syndrome. A pathological condition develops, as a rule, at the age of 2 to 10 years.
If the acetone syndrome is of a primary nature, the disease debuts suddenly and is manifested by bouts of indomitable vomiting with a characteristic smell of acetone (up to 20-30 or more times a day), lasting from several hours to several days, in combination with ketonuria and ketonemia (ketone bodies in the blood and urine).
In children, ketoacidosis is manifested by bouts of repeated vomiting with the smell of acetone
Secondary, the syndrome develops against the background of infectious diseases, acute inflammatory processes, surgery and other conditions accompanied by impaired energy metabolism and activation of the production of counterinsular hormones (for example, glucocorticosteroids or thyroid hormones).
In the case of decompensation, signs of CNS involvement appear (headache, drowsiness, lethargy), inflammatory changes in the gastrointestinal tract caused by irritation of the mucous membrane (nausea, pain in the stomach and around the navel, bloating, upset stools), body temperature rises, and symptoms of dehydration increase.
Acetonemic syndrome in children can resolve on its own within a few days or against the background of ongoing therapy.
Diagnostics
Diagnosis of ketoacidosis consists of an assessment of the characteristic clinical picture and the results of laboratory research methods:
- general urine analysis (glucose, ketone bodies, proteinuria is possible);
- biochemical blood test [hyperglycemia (usually 20-30 mmol / l), hyperketonemia (can be determined normally), increased levels of creatinine, urea];
- identification of a shift in acid-base balance (decompensated metabolic acidosis).
Treatment
Treatment of ketoacidosis is carried out urgently, patients are admitted to the specialized department of the hospital, in case of coma - to the intensive care unit.
The main directions of pharmacotherapy:
- infusion therapy;
- insulin therapy in the case of a diabetic nature of the developed condition;
- correction of acid-base balance (buffer solutions);
- correction of electrolyte shifts;
- one or two intravenous administration of anticoagulants for the prevention of disseminated intravascular coagulation;
- means influencing the processes of tissue metabolism.
With the development of ketoacidotic coma, patients are urgently delivered to the intensive care unit
Possible complications and consequences
Complications of ketoacidosis can include:
- progression to ketoacidotic coma;
- swelling of the brain;
- disseminated intravascular coagulation (disseminated intravascular coagulation);
- pulmonary edema;
- acute heart failure;
- acute renal failure;
- heart rhythm disturbances as a result of hypokalemia;
- aspiration of gastric contents (asphyxia, aspiration pneumonia).
Forecast
With timely diagnosis and urgently started therapy, the prognosis is favorable. The prognosis worsens with the development of life-threatening complications.
Prevention
- Compliance with the dosage regimen of hypoglycemic drugs, the recommendations of the attending doctor.
- Correction of the dose of drugs before the proposed surgical intervention, during pregnancy, against the background of stress, etc.
- Refusal to abuse alcoholic beverages.
- Careful monitoring of the health of devices for the administration of insulin and measuring the level of glycemia, the shelf life of drugs.
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Olesya Smolnyakova Therapy, clinical pharmacology and pharmacotherapy About the author
Education: higher, 2004 (GOU VPO "Kursk State Medical University"), specialty "General Medicine", qualification "Doctor". 2008-2012 - Postgraduate student of the Department of Clinical Pharmacology, KSMU, Candidate of Medical Sciences (2013, specialty "Pharmacology, Clinical Pharmacology"). 2014-2015 - professional retraining, specialty "Management in education", FSBEI HPE "KSU".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
