DR. OLASOPE A.C REGISTRAR ENDOCRINOLOGY UNIT.. OUTLINE Introduction. Pathophysiology. Effects. Diabetic Ketoacidosis Vs Hyperglycaemic Hyperosmolar State.

Slides:



Advertisements
Similar presentations
DIABETIC KETOACIDOSIS. Diabetes Mellitus {sugar diabetes} An ancient disease Names in ancient times by Greek physicians The noted that those with diabetes.
Advertisements

Water, Electrolyte, and Acid–Base Balance
Long-term Complications of Type 2 Diabetes
Diabetic Ketoacidosis and Hyperglycemia
Water, Electrolytes, and
1 Water, Electrolyte, and Acid- Base Balance Chapter 18 Bio 160.
ILA: DIABETES Ass Prof Dr. Gihan Sharara. Questions (Based on basic biochemistry) What is hyperglycemia? Why was there hyperglycemia in this patient?
Lactic Acidosis Dr. Usman Ghani 1 Lecture Cardiovascular Block.
Diabetic keto-acidosis (DKA) DKA or Hyperglycemia coma is defined when blood sugar mg/dl Is primarily seen in I.D.DM - can be seen in NIDDM. DKA.
Hyperglycaemia Diabetes Outreach (August 2011). 2 Hyperglycaemia Learning objectives >Can state what hyperglycaemia is >Is aware of the short term and.
CLINICAL CHEMISTRY (MLT 301) CARBOHYDRATE LECTURE ONE
Endocrine Disorders Dr. Naiema Gaber
Chapter 7— The Pancreatic Islets focusing on insulin 7-1.
Endocrine Diseases Dr/Abd Elghany Hefnawy T3&T4 PTH Anterior Posterior PAO Insulin Glucagon Adrenalin,Noradrenalin Corticosteriods.
Diabetes Mellitus.
Metabolic complications of Diabetes Mellitus
Diabetes and Aging MCB 135K Laura Epstein 4/14/06.
Hormonal control of circulating nutrients Overview: The need for glucose and nutrient homeostasis Interchange of nutrients / fuel stores Insulin:secretion.
Homeostatic Control of Metabolism
MLAB 2401: Clinical Chemistry Keri Brophy-Martinez
Endocrine Physiology PANCREAS Dr. Meg-angela Christi M. Amores.
Absorptive (fed) state
Diabetes mellitus.
Diabetic Ketoacidosis
Diabetic Ketoacidosis DKA)
Management of diabetic ketoacidosis and hypoglycemia Prof. Hanan Hagar.
Ketogenesis & Ketolysis
Unit Fourteen: Endocrinology and Reproduction
KETONE BODY METABOLISM Dr.Siddiqui Abdulmoeed Associate Professor of Biochemistry College of Medicine Al-jouf University.
Hormonal regulation of carbohydrate metabolism
A and P II Glucose Metabolism. 120 grams of glucose / day = 480 calories.
Regulation of Metabolism Lecture 28-Kumar
Brooks ch 9 p ; –Some small sections already covered Outline Maintenance of Blood Glucose during exercise –Feed forward Control - SNS –Feed.
Adult Medical-Surgical Nursing Endocrine Module: Acute Complications of Diabetes Mellitus.
Endocrine Block Glucose Homeostasis Dr. Usman Ghani.
PRINCIPLES OF HUMAN PHYSIOLOGY THIRD EDITION Cindy L. Stanfield | William J. Germann PowerPoint ® Lecture Slides prepared by W.H. Preston, College of the.
Endocrine Physiology The Endocrine Pancreas Dr. Khalid Al-Regaiey.
Endocrine System Week 8 Dr. Walid Daoud A. Professor.
Diabetic Ketoacidosis (DKA)
Management of diabetic ketoacidosis Prof. M.Alhummayyd.
Clinical Pathology B Case A Acute Diabetes The case history Mr CB, aged 40, has had type 1 diabetes since he was a child. He was brought in to the A &
DENTAL BIOCHEMISTRY 2015 LECTURE 10 GLUCONEOGENESIS Michael Lea.
Glucose Homeostasis By Dr. Sumbul Fatma.
DR. OLASOPE A.C REGISTRAR ENDOCRINOLOGY UNIT.
Overview of Carbohydrate Metabolism: The importance of regulating blood glucose levels.
Endocrine Physiology The Endocrine Pancreas. A triangular gland, which has both exocrine and endocrine cells, located behind the stomach Strategic location.
Management of diabetic ketoacidosis (DKA) Prof. M.Alhummayyd.
Acute Diabetes Case B By: Abdullah Osman Christine Tanzil Ayse Togac.
Hyperglycemic Emergencies Dr. Miada Mahmoud Rady Ems/474 Endocrinal Emergencies Lecture 3.
Diabetic Ketoacidosis.  An anion gap acidosis due to severe insulin deficiency and excess of counterregulatory hormones.
Endocrine Physiology The Endocrine Pancreas Dr. Khalid Al-Regaiey.
Diabetic Ketoacidosis DKA PHCL 442 Lab Discussion 6 Raniah Al-Jaizani M.Sc.
(Renal Physiology 11) Acid-Base Balance 3
Diabetes mellitus.
Hormonal Control During Exercise. Endocrine Glands and Their Hormones Several endocrine glands in body; each may produce more than one hormone Hormones.
Lecture 1 Session Six Control of Energy Metabolism Dr Majid Kadhum.
Diabetes Mellitus Part 1 Kathy Martin DNP, RN, CNE.
Management of diabetic ketoacidosis and hypoglycemia Prof. Hanan Hagar.
Endocrine System (part 2) Keri Muma Bio 6. Pancreas Located behind the stomach Has both exocrine and endocrine functions.
Calcium Homeostasis By Dr. Shereen Samir. Normal level of calcium Calcium is the most abundant essential mineral in the human body. Calcium is the most.
Carbohydrate metabolism (disorders)
Endocrine Block Glucose Homeostasis Dr. Usman Ghani.
Diabetic Ketoacidosis (DKA)
Management of diabetic ketoacidosis and hypoglycemia
The Endocrine Pancreas
Glucose Homeostasis By Dr. Sumbul Fatma.
Diabetic Ketoacidosis (DKA)
Management of diabetic ketoacidosis
18. Pancreatic function and metabolism
The Endocrine Pancreas
Presentation transcript:

DR. OLASOPE A.C REGISTRAR ENDOCRINOLOGY UNIT.

OUTLINE Introduction. Pathophysiology. Effects. Diabetic Ketoacidosis Vs Hyperglycaemic Hyperosmolar State. Summary. References.

Insulin Glucagon Epinephrine Cortisol Growth Hormone INTRODUCTION. Two hormonal abnormalities: – Insulin deficiency and/or resistance. – Glucagon excess increased secretion of catecholamines and cortisol

These will result in abnormal Metabolism of: – Fat – Carbohydrate – Protein

Normally… Hyperglycemia ↑Insulin ↑Glucose uptake ↓Glucose production ↓ Gluconeogenesis ↓ Glycogenolysis Normoglycemia

Hyperglycemia ↑Insulin ↓Glucose uptake ↑Glucose production ↑Glucose production ↑ Gluconeogenesis ↑ Glycogenolysis Hyperglycemia

Fat metabolism ↓insulin & ↑cathecholamines → Lipolysis ↑lipolysis →→ elevation of Free Fatty Acids in plasma – mobilization to the liver – Normally, these would be converted into Triglycerides & Very Low Density Lipoproteins, – but the presence of GLUCAGON alters the hepatic metabolism to form ketone bodies Ketone bodies Acetoacetate Acetone β-hydroxbutyrate

EFFECTS OF KETONES Weak acids which dissociate completely at normal pH Create a major H + load that soon exceeds normal buffering mechanisms Hyperventilation eliminates some of the acid Some are lost in urine buffered by phosphate and ammonia While some have Na + as the accompanying cation

EFFECT OF EXCESS H+ Negative ionotropic effect causing peripheral vasodilation, resulting in ↓ BP, warm extremities & ↑ or normal body temp If pH falls below 7.0, there may be inhibition of the CNS →→ paradoxical normal RR

CARBOHYDRATE METABOLISM Insulin deficiency ↓ hepatic level of fructose-2,6-bisphosphate, which alters phosphofructokinase & fructose- 1,6-bisphosphatase activity thus promoting GLYCOLYSIS. Decrease in GLUT-4 Transporter

CARBOHYDRATE METABOLISM. Glucagon excess Depresses GLYCOLYSIS by↓ pyruvate kinase activity causing the intermediates to be shuttled in gluconeogenesis. Activates GLUCONEOGENESIS by↑phosphoenolpyruvate carboxykinase activity Promotes GLYCOGENOLYSIS

Protein metabolism There will be ↑ protein breakdown & production of amino acids, which will be used in gluconeogenesis

Events Dehydration – Osmotic Diuresis – blood glucose exceeds the renal threshold ( mg/dl) – Vomiting – Hyperventilation – Impaired consciousness – ↓ intake

Events contd. Metabolic acidosis – due to ↑ ketones – Compensatory mechanisms (1) respiratory compensation, (2) intracellular buffering – excess H+ goes into cells in exchange for potassium. (3) HCO3 - buffering system.

Events contd. Ionic changes – – A general loss of electrolytes due to osmotic diuresis. – K + – intracellular buffering mechanism shifts K + out of cells so even if there is ↓ total K + in the body, serum K + may initially be normal or even ↑ This K + is further lost through the kidneys

PARADOXES OF HYPERGYCAEMIC EMERGENCIES. – Hyperglycaemia despite ↓ intake – Polyuria despite dehydration – Catabolic state despite hyperglycaemia

DKA Vs HHS Degree of hyperglycemia – HHS > DKA Pts with DKA present earlier due to symptoms of ketoacidosis DKA pts are usually younger and have a better GFR, thus excreting more glucose through urine Ketoacidosis – Absent/Minimal in HHS….why? Minimal insulin may be sufficient to minimize ketosis but does not control hyperglycemia. Decreased adipocytes in the elderly.

In summary…. HEs result from imbalance between Insulin and Counter regulatory hormones. Hyperglycaemia results from ↑ hepatic glucose production and its ↓ uptake. Ketoacidosis results from lipolysis with release of FFA which serves as precursors for ketone bodies. Insulin levels in HHS are insufficient to allow appropriate glucose utilization but are adequate to prevent lipolysis.

REFERENCES. Gale EAM, Anderson JV Diabetes mellitus and other disorders of metabolism in Kumar P, Clark M, Kumar and Clark’s Clinical Medicine, pp , ch th ed. Saunders Elsevier 2012 Eisenbarth GS,Buse JB Type 1 diabetes mellitus in Melmed S, Polonsky KS, Larsen PR, Kronenberg HM Williams Textbook of Endocrinology pp ch th ed. Saunders Elsevier 2011 Fauci et al, 2012; Harrison’s principles of internal medicine 18th edition