hello in this video we're going to talk about diabetic keto acidosis this is an introduction and overview it is important to know that diabetic keto acidosis is a medical emergency especially in type 1 diabetic patients but it is known that it can also occur in type 2 diabetes as the name suggest it has to do with acidity so there's increase in acidity in the blood essentially the signs and symptoms of diabetic keto acidosis is nausea vomiting polyurea polydipsia weight loss hyperventilation known as kmal breathing now diabetic keto acidosis doesn't occur out of the blue there's usually some triggers and these triggers these etiologies it can be remembered as the five eyes the five eyes are in infection intoxication inappropriate withdrawal of insulin inunction and intercurrent illness and these five triggers they cause what we know as diabetic keto acidosis so let's go into the pathophysiology briefly if you want to know more about the functions of insulin watch um a video I have on the FED state which is under biochemistry anyways the pancreas normally produces insulin however in Diabetes Type 1 there is an autoimmune attack on the B cells which normally produce insulin and therefore insulin is not being produced anymore so we have a decreased in insulin insulin is an important hormone and because we have a decrease in insulin this causes some problems first it means that there it means that gluconeogenesis is not inhibited and so we get gluconeogenesis we get more production of glucose we also get increased glycogenolysis and we get a decrease in glycolysis all of which will result in more glucose in the blood so we get hyperglycemia hyper perog glycemia results in glucose being peed out so we get glucose Uria glucose draws water so we get poly UA and we also get dehydration as a result because we lose a lot of water and we are dehydrated we get polydipsia we we get thirsty it's also important to note that the decrease in insulin the absence of insulin means that fat breakdown occurs it's a very important concept to understand fat breakdown occurs especially if the body is not receiving enough energy so in um in periods of infection or feeling ill the body will start breaking down the fat because glucose is not present and because glucose is not being taken up fats are gets broken down from adapost tissue um to form free fatty acids which then go to the liver and under go ketogenesis to make more Ketone bodies it does this because the body needs some form of energy some form of Supply because glucose is not working or because glucose is not present with so much ketones being made we get ketonemia we get high ketones in the blood and then subsequently this means that we get Ketone UA we are peeing out ketones and it's also important to know that ketones are acidic ketones are acids and so they reduce the pH in the blood but also they will reduce the pH in urine this is the main pathophys we see in dka so if a person presents with the signs and symptoms we spoke of a thorough history and examination needs to be done and appropriate management needs to be performed which includes checking the Airways checking breathing and circulation in circulation IV access is important for a few reasons first to get Bloods for investigation it's also important here to get a base serum potassium level after getting the Bloods for investigation administering IV fluids saline and also administering ation of insulin slowly is very important administration of insulin is important because we want the cells in the body to take up the the glucose that is in the blood while this is going on investigations have to be performed so ABG which is arterial blood gas is very important to measure the pH in the blood and this needs to be done regularly Bloods as we mentioned full blood count eu's for infections and also electrolyte abnormalities and dehydration urine analysis is important to check and monitor if there's glucose ketones and infections ECG is performed to check for arrhythmias in case of pottassium hyperemia or hypokalemia so again monitoring p by doing regular arterial blood gas is important and also it is important to monitor serum potassium levels the reason it is important to measure serum potassium levels is insulin is being administered because insulin will actually cause hypokalemia if you get hypokalemia you can actually trigger an arhythmia sometimes calcium gluconate can be administered to protect the heart from um these hypokalemia induced arrhythmias anyways monitoring is continuous check pH and check Bloods after a while you can switch the fluids to 0. 5% saline and 5% dextrose this is done when blood glucose goes down at least about 14 mm per liter let's just say again for diabetic Keto acidos monitoring is Essentials monitor Bloods eu's perform abgs to check for pH and monitor urine output and also the changes in urine pH glucose and ketones