Thursday, 15 October 2015

DKA

DIABETIC KETO ACIDOSIS is life threatening complication in diabetic patients who need insulin therapy. I stress again who needs insulin therapy.....
KETOACIDOSIS occurs more often in type I diabetic patients no matter how good is the compliance with the insulin therapy. One precipitating factor and the DKA happens. Contrary to this patients with type II Diabetes Mellitus develop DKA only either when they have insulin secreating islet beta cells exhausted so on insulin therapy or when the precipitation is either multifactorial or very intense.
The pathophysiology behind is the fact that although the total insulin released in type II DM is much less compared to type I DM but whatever insulin is released is in the portal system and directly reaches the site of ketogenesis i.e liver and thus prevents ketogenesis in the mitochondria of the hepatocytes while in type I most of the insulin injected in periphery hardly reach the portal system while being utilised in the periphery especially in precipitating situations for DKA like Ischemia(Cardiovascular, Cerebrovascular and peripheral vascular), infarction, inadequate insulin , pregnancy and drugs like cocain

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