DKA in Hypoglycemia

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I know with hyperglycemia the body can go into DKA. But would the same thing happen in hypoglycemia as the cells are not receiving the sugars and they need the sugars to function. I know the body will go into DKA with starvation so wouldnt it go into DKA with hyglycemia? I looked it up in my text and it doesnt say anything other than the normal things that happen with hypo and hyper. Just curious. Thanks!

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If the brain does not receive glucose it will begin to shut down and death will ensue.

Unlike hyperglycemia, hypoglycemia has a very short window of therapeutic time.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

They are two different entities. While they will both cause acidosis the mechanism of acidosis is different. DKA is from ketosis and acidosis from Hypoglycamia is lactic acid.

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Diabetic ketoacidosis (DKA) results from dehydration during a state of relative insulin deficiency, associated with high blood levels of sugar level and organic acids called ketones. Diabetic ketoacidosis is associated with significant disturbances of the body's chemistry.

Diabetic ketoacidosis occurs when a person with diabetes becomes dehydrated. As the body produces a stress response, hormones (unopposed by insulin due to the insulin deficiency) begin to break down muscle, fat, and liver cells into glucose (sugar) and fatty acids for use as fuel. These hormones include glucagon, growth hormone, and adrenaline. These fatty acids are converted to ketones by a process called oxidation. The body consumes its own muscle, fat, and liver cells for fuel.

In diabetic ketoacidosis, the body shifts from its normal fed metabolism (using carbohydrates for fuel) to a fasting state (using fat for fuel). The resulting increase in blood sugar occurs, because insulin is unavailable to transport sugar into cells for future use. As blood sugar levels rise, the kidneys cannot retain the extra sugar, which is dumped into the urine, thereby increasing urination and causing dehydration. Commonly, about 10% of total body fluids are lost as the patient slips into diabetic ketoacidosis. Significant loss of potassium and other salts in the excessive urination is also common.

Diabetic Ketoacidosis Causes, Symptoms, and Treatment by eMedicineHealth.com

An insulin reaction occurs when a person with diabetes becomes confused or even unconscious because of hypoglycemia (hypo=low + glycol = sugar + emia = in the blood) caused by insulin or oral diabetic medications. The terms insulin reaction, insulin shock, and hypoglycemia (when associated with a person with diabetes) are often used interchangeably.

In normal physiology, the body is able to balance the glucose (sugar levels) in the bloodstream. When a person eats, and glucose levels start to rise, the body signals the pancreas to secrete insulin. Insulin "unlocks the door" to cells in the body so that the glucose can be used for energy. When blood sugar levels drop, insulin production decreases and the liver begins producing glucose. Interestingly, brain cells do not need insulin to access the glucose in the blood stream. Brain cells also cannot store excess glucose, so when blood sugar levels drop, brain function is one of the first parts of the body to become affected.

http://navyemergencymedicine.com/wp-content/uploads/2010/01/2011-LLSA-Metabolic-Emergencies.pdf

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So in hypoglycemia it is lactic acidosis that the body will go into with carbohydrate deprivation?

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Like most animal tissues, brain metabolism depends primarily on glucose for fuel in most circumstances. A limited amount of glucose can be derived from glycogen stored in, but it is consumed within minutes. For most practical purposes, the brain is dependent on a continual supply of glucose diffusing from the blood into the interstitial tissue within the central nervous system and into the neurons themselves.

Therefore, if the amount of glucose supplied by the blood falls, the brain is one of the first organs affected. In most people, subtle reduction of mental efficiency can be observed when the glucose falls below 65 mg/dl. Impairment of action and judgment usually becomes obvious below 40 mg/dl. Seizures may occur as the glucose falls further. As blood glucose levels fall below 10 mg/dl, most neurons become electrically silent and nonfunctional, resulting in coma.

The importance of an adequate supply of glucose to the brain is apparent from the number of nervous, hormonal and metabolic responses to a falling glucose level. Most of these are defensive or adaptive, tending to raise the blood sugar via glycogenolysis and gluconeogenesis or provide alternative fuels. If the blood sugar level falls too low the liver converts a storage of glycogen into glucose and releases it into the bloodstream, to prevent the person going into a diabetic coma, for a short period of time.

Prolonged, severe hypoglycemia can produce lasting damage of a wide range. This can include impairment of cognitive function, motor control, or even consciousness. The likelihood of permanent brain damage from any given instance of severe hypoglycemia is difficult to estimate, and depends on a multitude of factors such as age, recent blood and brain glucose experience, concurrent problems such as hypoxia, and availability of alternative fuels causing a build up of lactic acid.

Hypoglycemia - MayoClinic.com

So you are acidosis from ketoacidosis or lactic acid buildup from anaerobic breakdown of energy stores and coma. You can have a normal glucose and still be acidotic from the ketones.

My favourite resource...medscape.

Metabolic acidosis is an acid-base disorder characterized by a decrease in serum pH that results from either a primary decrease in plasma bicarbonate concentration ([HCO3-]) or an increase in hydrogen ion concentration ([H+]). It is not a disease but rather a biochemical abnormality. The clinical manifestations of a metabolic acidosis are nonspecific, and its differential diagnoses include common and rare diseases.

The underlying disorder usually produces most of the signs and symptoms in children with a mild or moderate metabolic acidosis

1331339-1331344-906440-1707563.jpgMedscape: Medscape Access requires registration but is free.

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Specializes in Hospital Education Coordinator.

Thanks Esme12 for your well worded contribution!

to original poster - hypoglycemia does not create DKA because there are no ketones to build up in the system.

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Thank you for the information! This definitly clarifies things!

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