37
main cause of the decline in the mental state of DKA patients and are more risky for
children. Metabolic acidosis is a clinical symbol of DKA. Physiologically, the
human body tries to recompense and remove acid by using deep and fast breathing,
a process known as Kussmaul’s respiration, and attempting to consume more bicarbonate. Potassium is transported into the blood in acidosis, which is transferred in
the kidneys by osmotic diuresis. This process leads to pseudohyperkalemia or the
initial high blood levels, which can quickly become hypokalemia by DKA treatment [75].
Signs and Symptoms
DKA patients become sick after dehydration. They usually report polyphagia, polydipsia, and polyuria. Patients with severe DKA will show a change in mental status
during the initial investigation. There may be tachycardia, shortness of breath, and
changes in body position. In addition, etco2 will be low, depicting the presence of
metabolic acidosis in DKA. Signs and symptoms of DKA include [76]:
• Abdominal pain (especially common in children)
• Nausea and vomiting
• Fatigue and weakness
• Fruity breath odor
• Tachypnea/hyperpnea
• Orthostatic hypotension
• Increased diuresis
• Hemodynamic shock in severe cases
• Altered LOC
• Cardiac dysrhythmia
• Seizures
Hyperosmolar Hyperglycemic Nonketotic Coma
Hyperosmolar hyperglycemia nonketotic coma (HHNC) is a severe diabetes complication. It has 10–50% mortality rate. It is hard to distinguish DKA from HHNC
but we can find it by checking patient’s medical history, raised blood sugar levels,
and a lack of low etco2. Usually patients with type 2 diabetes develop HHNC and it
is elicited by the same stressor that causes DKA. This condition has the following
characteristics:
• Raised plasma glucose concentration, usually >600 mg/dL (>33.3 mmol/L)
• Increased serum osmolality, usually >315 mOsm/kg
• Lack of ketone production
HHNC is accompanying with substantial dehydration and decreased mental status. Sometimes it develops into a complete coma. Compared with DKA, acidosis
1 Physiology of Endocrine System and Related Metabolic Disorders
main cause of the decline in the mental state of DKA patients and are more risky for
children. Metabolic acidosis is a clinical symbol of DKA. Physiologically, the
human body tries to recompense and remove acid by using deep and fast breathing,
a process known as Kussmaul’s respiration, and attempting to consume more bicarbonate. Potassium is transported into the blood in acidosis, which is transferred in
the kidneys by osmotic diuresis. This process leads to pseudohyperkalemia or the
initial high blood levels, which can quickly become hypokalemia by DKA treatment [75].
Signs and Symptoms
DKA patients become sick after dehydration. They usually report polyphagia, polydipsia, and polyuria. Patients with severe DKA will show a change in mental status
during the initial investigation. There may be tachycardia, shortness of breath, and
changes in body position. In addition, etco2 will be low, depicting the presence of
metabolic acidosis in DKA. Signs and symptoms of DKA include [76]:
• Abdominal pain (especially common in children)
• Nausea and vomiting
• Fatigue and weakness
• Fruity breath odor
• Tachypnea/hyperpnea
• Orthostatic hypotension
• Increased diuresis
• Hemodynamic shock in severe cases
• Altered LOC
• Cardiac dysrhythmia
• Seizures
Hyperosmolar Hyperglycemic Nonketotic Coma
Hyperosmolar hyperglycemia nonketotic coma (HHNC) is a severe diabetes complication. It has 10–50% mortality rate. It is hard to distinguish DKA from HHNC
but we can find it by checking patient’s medical history, raised blood sugar levels,
and a lack of low etco2. Usually patients with type 2 diabetes develop HHNC and it
is elicited by the same stressor that causes DKA. This condition has the following
characteristics:
• Raised plasma glucose concentration, usually >600 mg/dL (>33.3 mmol/L)
• Increased serum osmolality, usually >315 mOsm/kg
• Lack of ketone production
HHNC is accompanying with substantial dehydration and decreased mental status. Sometimes it develops into a complete coma. Compared with DKA, acidosis
1 Physiology of Endocrine System and Related Metabolic Disorders