Chemistry Presentation: Diabetic Ketoacidosis BY: Leor Surilov

Table of Contents What is Diabetic Ketoacidosis (DKA)? Biochemistry of DKA Complications/symptoms of DKA Why is this important to discuss? How is this related to chemistry? Conclusion

WHAT is Diabetic Ketoacidosis (DKA) Hyperglycemia Acidosis Ketosis Diabetic Ketoacidosis The Definition of DKA is the presence of the following: Hyperglycemia: meaning there is a high concentration of sugar in your blood Ketosis: Is the increase of the production of ketone bodies in the body 3) Acidosis: Is the decrease of the pH of the body (pH < 7.3)

Biochemistry of Diabetic Ketoacidosis https://www.youtube.com/watch?v=t5h4YDsfS2c

Complications/Symptoms of DKA Lethargy (lack of energy) and drowsiness Vomiting Dehydration Deep breathing (hyperventilation) Infection Abdominal pain Hyponatraemia ( low levels of sodium in your body) Shock

Why is this Important DKA commonly occurs in patients with type 1 diabetes, and is usually the initial presentation for many type I diabetics Type I diabetes, is an autoimmune disease the leads to the destruction of pancreatic ß cells that are involved with hormone insulin production Insulin is a hormone that allows glucose to enter the cell throughout the body and is therefore maintains plasma glucose levels Therefore without insulin the body can not use glucose (carbohydrates) and must use an alternative energy source

Diabetes According to the American Diabetes Association: Prevalence: in 2012, 29.1 million Americans, or 9.3% of the population, had diabetes Approximately 1.25 million American children and adults have type 1 diabetes Prevalence in seniors is 25.9% (diagnosed and undiagnosed) Diabetes remains the 7th leading cause of death in the US in 2010

How is this Related to Chemistry: Introduction Acid-Base Balance The pH of the body is maintained within a very narrow in order to function normally Normal plasma [H+] is low The presence of buffers throughout the body help maintains proper pH Two components of the body that generally remove acids are: Lungs (volatile acids) Kidneys (non-volatile acids) Retrieved from: http://altered-states.net/barry/update178/DigestiveTract.jpg

How is this Related to Chemistry: Lungs The primary buffer in the body is bicarbonate, which contributes to the acid-base balance created by carbon dioxide DKA most often presents with hyperventilation in order to adjust the acidosis This is Le Chatelier’s Principle, the increase breathing out of carbon dioxide shifts the equilibrium to the right The shift involves hydrogen ions combining with bicarbonate to produce carbonic acid, which leads to the dissociating into carbon dioxide to compensate This leads to the decrease in [H+] Retrieved from: https://fmss12uchemd.files.wordpress.com/2013/05/eqn10.jpg

How is the Related to Chemistry: Kidneys The kidney is a filter and contributes to acid-base balance, either through adjusting the electrolyte balance or by removing non-volatile acids such as sulfate and phosphate The kidney does this by a process called ammoniageneisis, which bicarbonate is produced and ammonium is excreted in urine This pathway uses Le Chatelier’s Principle by decreasing [H+] shifting the equilibrium to compensate Retrieved from: http://www.eclinpath.com/wp-content/uploads/renal-ammonia1.jpg

Conclusion DKA often occurs in people with type I diabetes, usually as their initial presentation DKA involves products that decrease the normal pH (acidosis) The body uses acid-base chemistry to maintain the normal pH using buffers The lungs and kidneys use Le Chateliers principle in the bicarbonate/carbon dioxide equation to adjust the acid- base balance

References Brown, T. A. (2012). Rapid review physiology. Philadelphia, PA: Mosby/Elsevier. Longmore, M., Wilkerson, I. B., Baldwin, A., & Wallin, E. (2014). Oxford Handbook of Clinical Medicine (9th ed.). Oxford: Oxford University Press MCAT General Chemistry Review Notes. (2010). New York, NY: Kaplan. Statistics About Diabetes. (n.d.). Retrieved June 29, 2016, from http://www.diabetes.org/diabetes- basics/statistics/?referrer=https://www.google.ca/