Diabetic Keto acidosis (DKA) –
DKA is a potentially life threatening complication in patient suffering from Diabetes. It happens predominantly in those with Type 1 Diabetes but can also occur in those with Type 2 Diabetes.
DKA results from a shortage of insulin. As a result, the body starts burning fatty acids and producing ketone bodies.
DKA may also be the first symptom of previously undiagnosed diabetes. So it is important to ask for family history of diabetes in all patients going for hair transplant surgery and take all necessary precautions.
Signs and symptoms :-
The earliest signs and symptoms of Diabetic Ketoacidosis are:-
- Dehydration
- Polyuria
- Vomiting
- Abdominal Pain
- If the condition worsens, these may be followed by typical deep, gasping breathing called Kussmaul breathing.
If left unchecked or undiognesed it can progress to mental disorientaltion and eventually coma.
Clinical Examination:-
There will be clinical evidence of dehydration such as dry mouth as well as reduced skin turgor. Tachycardia (rapid heart beat) and low blood pressure may be observed. A ketotic odour (fruity smell) may also be present.
Diagnosis -
At the earliest symptoms, suitable tests should be performed. These tests include :-
1.Blood Sugar level
2.Blood and urine ketone levels
3.Blood Potassium levels
Treatment
Diabetic Ketoacidosis is distinguished from other diabetic emergencies by the presence of large amounts of ketones in urine and marked metabolic acidosis.
Management:-
- Fluid replacement
- Insulin administration
- Potassium level monitoring and replacement
It is very important to remember the coordination between Insulin administration and potassium levels in DKA.
Insulin administration in conditions like DKA may decrease potassium level in blood (hypokalemia) by redistributing it into cells.
In addition, potassium has also been lost in urine because of diuresis.
Therefore, blood potassium levels should be measured during the treatment/insulin administration.
Hypokalemia often occurs in during the treatment of DKA leading to irregularities in heart rate/pulse. If not treated in time hypokalemia can lead to Cardiac arrest.
Continuous observation of the heart rate is recommended, as well as repeated measurement of the potassium levels and addition of potassium to the intravenous fluids once levels fall below 5.3 mmol/l. If potassium levels fall below 3.3 mmol/l, insulin administration must be stopped to allow correction of the hypokalemia.
Resolution:-
Resolution of DKA is defined as general improvement in the symptoms, such as the ability to tolerate oral nutrition and fluids, normalization of blood acidity (pH>7.3), and absence of ketones in blood (<1 mmol/l) or urine. Once this has been achieved, insulin may be switched to the usual subcutaneously administered regimen, and intravenous administration discontinued.
If Diabetic Ketoacidosis occurs in someone with Type 2 diabetes, their condition is called “ketosis prone type 2 diabetes”. The exact mechanism for this phenomenon is unclear, but there is evidence both of impaired insulin secretion and insulin action. Once the ketoacidosis has been treated, insulin production resumes and often the patient may be able to resume diet or tablet treatment as normally recommended in type 2 diabetes.
Suggestion for the Hair Transplant Centre.
1.Blood and urine testing facility including blood sugar level
2.Blood and urine Ketone levels measurement testing
3.Blood potassium level testing,
should all preferably be available in the centre.
The doctor and/or the technicians should be well trained in performing these tests. Simultaneously, the doctor and the technicians should be well trained to suspect DKA by its earliest signs and symptoms.
