DEFINITION OF KETOACIDOSIS
Diabetic ketoacidosis (DKA) is a state of uncontrolled diabetes and it is characterized by hyperglyceraia, a high anion gap acidosis, and the presence of ketonemia and ketonuria (ketone bodies in the blood and urine). Although it can occur in patients with type 2 diabetes (during periods of severe stress), DKA primarily occurs in patients with type 1 (iRocket, 2005).
Type 1 diabetes is caused by the (usually autoimmune) destruction of the pancreatic beta cells, which leads to an absolute insulin deficiency. Thus, patients with type 1 have an absolute requirement for insulin and will develop DKA if they do not receive it. The lack of insulin, the increase in glucagon (normally suppressed by insulin), and the high levels of the stress hormones epinephrine and cortisol all contribute to hyperglycemia in DKA.
But despite such a large amount of sugar in the blood, the body's organs are essentially starved for fuel because there is not enough insulin to stimulate their uptake of glucose. In an attempt to create an alternate source of energy, these organs begin' diverting their metabolic resources to produce ketone bodies. Although ketone bodies allow cells to maintain a very minimal level of function, they are acids, and so can cause a dangerous anion gap acidosis. The most common underlying causes of DKA are infection (which produces an increased need for
insulin) and noncompliance with one's insulin regimen. Because patients with type.
More information about DEFINITION OF KETOACIDOSIS
1 diabetes have an absolute insulin deficiency, either of these scenarios can turn an already tenuously balanced metabolic state into a severely ketoacidotic one.
The first full description of diabetic ketoacidosis is attributed to Julius Dreschfeld, a German pathologist working in Manchester, United Kingdom. In his description, which he gave in an 1886 lecture at the Royal College of Physicians in London, he drew on reports by Adolph Kussrnaul as well as describing the main ketones, acetoacetate and p-hydroxybutyrate, and their chemical determination.
The condition remained almost universally fatal until the discovery of insulin in the 1920s; by the 1930s, mortality had fallen to 29% and by the 1950s'it had become less than 10%.
The entity of cerebral edema due to DKA was described in 1936 by a team of doctors from Philadelphia (Eledrisi et a!., 2006). Ketoacidosis is a metabolic state associated with high concentrations of ketone
bodies, formed by the breakdown of fatty acids and the deamination of ami no acids.
In ketoacidosis, the body fails to adequately regulate ketone production causing such a severe accumulation of keto acids that the pH of the blood is substantially decreased. In extreme cases ketoacidosis can be fatal.