Describe the metabolic events that result in the signs and symptoms associated with DKA. Was Rachel in this state when she was admitted? What precipitating factors may lead to DKA?

Question

What will be an ideal response?

Answer 1

Precipitating factors that may lead to the complication of diabetic ketoacidosis are illness or infection, an inadequate insulin dose, initial manifestation of the disease, or emotional and physical stress. Diabetic ketoacidosis is a severe form of hyperglycemia, resulting from physiological responses to hyperglycemia and insulin deficiency. When sufficient insulin is not available to regulate blood glucose levels, hepatic gluconeogenesis and lipolysis are stimulated by counter-regulatory hormones in an attempt to provide a fuel source for cells and, ultimately, prevent starvation. This production of excessive glucose further increases blood sugar levels. Also stimulated by the presence of counter-regulatory hormones is the production of ketones in the liver. Ketones are produced as a byproduct of increased lipolysis that occurs from insulin deficiency and reliance on fat metabolism. Several symptoms occur with DKA, each relating back to an abnormal physiological process. For example, hyperglycemia causes polydipsia, polyuria, and polyphagia. Also associated with DKA is dehydration—these signs and symptoms often are present as well: poor skin turgor, and orthostatic hypotension from excessive fluid losses associated with hyperglycemia and ketonemia.
When Rachel was admitted, she had s/s of dehydration, polydipsia, polyuria, polyphagia, weakness, and lethargy (fainted at soccer) as well as ketones present in her urine. Thus, it can be concluded that she was in diabetic ketoacidotic state.