Question

Individuals with diabetes, if not controlled, can develop ketoacidosis. Based on what you now know about acid-base balance, what causes ketoacidosis and what treatment is necessary to prevent damage or death

Answer 1

Diabetic ketoacidosis (DKA) is severe metabolic disorder that occurs due to insulin deficiency, this condition causes the disruption of the normal acid base balance of our body.

In ketoacidosis there is build up acids in blood stream called ketones, In DKA the rate at which ketones are produced exceeds the rate at which they can be excreted, because of which they accumulate in the blood, this abnormal accumulation of ketones disrupts the normal buffering system of our body, ketones are strong acids, they completely dissociate at physiological pH, thereby increasing the amount of hydrogen ion produced, normally bicarbonate ion acts on hydrogen ion to produce carbonic acid, which is further converted into carbon di oxide and water, but the rate which body produces bicarbonate ion cannot keep up the pace of abnormal influx of hydrogen ions as a result the buffering system fails and the increasing hydrogen ion concentration lowers the pH as a result the patient suffers from metabolic acidosis. In severe DKA the pH can be as low as 7 (normal pH is aroung 7.35) and bicarbonate levels can be as low as 10 mmol / L (normal 24 mmol / L).

The most important measure to treat DKA is maintain normal blood glucose level and normal acid base level.

Adminstering of insulin, to maintain normal glucose level is considered.

Replacement of lost fluids by infusion of normal saline (metabolic acidosis can cause severe fluid loss)

Replacement of potassium levels.

If acidosis is severe bicarbonate infusion is given

Carefull monitoring of blood glucose, blood pH and fluid balance is essential.