Dr Ferox on Diabetic Ketoacidosis in five minutes

Hello everybody my name is Dr. FeroxAnd thanks for joining me on this little, very simplified rant about the glorious metabolic catastrophe that is diabetic ketoacidosisor DKA for shortyou would all know that in a normal animal the glucose that you eat goes into the cells where it’s turned into energy with thehelp of our friend of insulinIn a diabetic they don’t produce enough insulin on their own which is fineSo we inject it, and then they live a more or less normal lifebut in a DKAFor whatever reason they’ve been under dosed on insulinMaybe they’re stressed, maybe they’re sick. It doesn’t really matter why the resulting catastrophe is basically the sameWithout insulin, glucose does not get into your cells except by passive diffusionWhich is just not adequate and your cells are starving so they try and stay alive by metabolizing fatsWhich works, but the fats produce acidic compounds and ketonesThe acid on its own is a huge problem because acids denature proteins, and our friend insulin is a proteinSo when the acidity of the blood increases insulin becomes less functionalif they had any to start with and then everything gets worse very, very quicklyAcidification of the body on its own is one way that these patients can dieAcids cause proteins to denatureWhich is the same sort of process you get if you take a steak and you marinate it in lemon juice:It goes brown and soft and it changes, and that is not conducive to being aliveNow once you have them in the clinic and you start treating these poor cases you need to give them lots and lots of fluidsAnd you need to get them on to some effective insulin therapyThe amount of insulin you need varies depending on the patientAnd how sick they’ve been and for how long and whatever else is going onBut you give them enough insulin to get their blood glucose levels to drop to normal which puts glucoseBack into the cell where it can do its jobAnd when glucose enters the cell it drags its friend potassium with itAnd, a lot of these patients will drag a lot of potassium in with them into the cells which means the potassium in your bloodEnds up going through the floor and that can cause your heart to stop, so, that’s another way they like to dieFortunately, we can add lots of potassium to the intravenous fluidsBut if you add too much too quickly it will also cause the heart to stop and that’s obviously not goodBut doesn’t quite end thereAt least now we’ve got glucose in our cell which is where our cell wants it to beSo that it can make energy; and on a cellular level that means turning a molecule called ADP, which has two, phosphorousesInto ATPWhich has three phosphorousesWhich means you suddenly have a lot lessphosphorous floating aroundNow you might not know what phosphorous does, but when you have too much or too little of it all your red blood cellsexplodein an acute hemolytic crisisandThey can diethis is why sometimes our diabetics need blood transfusions when everything has really hit this catastrophic pointSo keeping these patients alive in the vet clinic is sometimes a real challenge, but when you pull it off. It just worksIt’s like magic because so much is going wrong and there is so much you can do to fix themIt does mean we need to monitor them every couple of hoursWe need to know what their acid base is doing what their glucose is doing what their potassium is doing what their phosphorous is doingAnd also what their PCV is doing which measures their red blood cell concentrationBecause all of these things can go wrong and they can all go wrong very very quickly, but you can fix them it just takeswell quite a lot of effort, butIt’s really good medicine when it worksIt’s really, really fun when you get it right, and you see something that was trying very, very hard to dieJust turn around and go back to being what it’s supposed to beSo that my friends, is the very, very simple version of diabetic ketoacidosisThanks for listening, and I will catch you next time