What is Ketoacidosis, Definition of ketoacidosis Coma:
Ketosis is the accumulation of ketone bodies (produced by breakdown of fat) in the blood and Acidosis is increased acidity of the blood, i.e PH of blood decreases. It is a serious condition that can also lead to coma. Usually seen in type 1 diabetic patients, may also appear in type 2 diabetes specially older patients. Diabetic acidosis is often initiated by an infection like Urinary track infection or chest infection.

Pathophysiology and causes of Diabetic Kitoacidosis Coma:
Usually we see DKA when you miss doses of insulin, as a result blood glucose level will rise, and body cells will start burning fat which leads to production of ketone bodies and acidosis.At the same time, the high secretion of glucose into the urine causes dehydration due to loss of water and salts. Ketoacidosis occurs when cells of body can not fulfilled their metabolic demand in absence of sufficient glucose. Instead, cells start getting energy by breakdown of fatty acids which results in formation of ketone bodies. PH of body will become acidic and body will try to eliminate acids by increasing rate and depth of acids.

Symptoms and signs of ketoacidosis:
Tiredness Fruity smell to breath like nail polish remover Increase thirst Polyuria increase urination. Weight-loss. Oral Thrush Muscle wasting. Aggression Confusion Agitation Irritation Emesis (vomiting), Abdominal pain. Loss of appetite. Flu-like symptoms. Lethargy and apathy. Patients breathe more deeply and rapidly. Unconsciousness (diabetic coma) after prolonged DKA.

Prevention of diabetic ketoacidosis
If you are ill and having an infection, always remember your body will need more insulin in such conditions, so try to increase your insulin dose during infectious illness, but before taking insulin should always check your blood glucose level. Keep tight control of your blood sugar level by regularly checking it with glucometer. Whenever you feel unwell, just check your blood glucose level. If you ever find that blood glucose is high, then go for your urine examination for presence of ketone bodies. You should always have ketone measuring urine strips at home.

Diabetic acidosis is often seen in stomach infection Gastritis, as you think that less insulin is needed if you are having symptoms of gastritis like nausea vomiting and reduced eating and this insufficient insulin may lead to acidosis.

How do you know if you have diabetic acidosis?
The diagnosis is made by: Always measure blood glucose – It is always high in diabetic ketoacidosis. Urine examination for ketone bodies a blood sample taken from an artery – it is done in the hospital and measures the PH of the blood. Doctor will also perform tests to rule out any infection.

How to treat diabetic ketoacidosis.
This condition usually requires hospital admission. Treatment consists of: Intravenous salt fluids like NaCl, KCl etc Insulin is given via intravenous drips. potassium supplements added to the infusion If infection is present then antibiotics are also added.

Prognosis is quit good, if diabetic ketoacidosis is diagnosed and treated earlier, patient usually recovers within few days, however if acidosis is not treated earlier, it may become life threatening.

Hyperosmolar nonketotic Coma

Diabetic Coma in Type 2 Diabetes Hyperglycaemic hyperosmolar nonketotic coma is a serious complication seen in type 2 diabetes patients with severe infection or stress. Diabetic coma is seen when blood glucose level becomes too high and there is severe dehydration. Unlike ketoacidosis which is usually seen in type 1 diabetes, in hyperosmolar stage we dont see any ketones in body and urine, and there is no acidosis. Diabetic hyperosmolar coma is usually seen in diabetic patients older than 60 years as they have altered sense of being thirsty and are more likely to become severely dehydrated. If there is severe loss of water from body, it can lead to shock, syncopy, coma and death

What are Causes of Diabetic Coma?
Severe Infection UTI, respiratory tract infection, bacterial meningitis,retropharyngeal abscess, hepatobiliary sepsis. Noncompliance with diet or insulin therapy Heart attack Renal failure Drugs (diuretics, steroids, phenytoin, ß -blockers, calcium channel blockers) Fever Illness Bleeding ulcer Blood clot hyperglycaemia Trauma CVA Pancreatitis

Symptoms of Hyperosmolar Coma:
Symptoms of hyperosmolar coma are produced due to hyperglycaemia and dehydration. Increased urination Increased thirst Severe Weakness Drowsiness Altered mental status Headache Restlessness Inability to speak Paralysis If you have any of these signs and symptoms, check your blood glucose and call your doctor if your blood glucose is high. Diabetic hyperosmolar coma typically seen when blood glucose increases to 600 mg/dL or more.

What are laboratory findings of Diabetic Coma patient.
• Severe hyperglycaemia (> 500mg/dl)
• Plasma hyperosmolality
• urea:creatinine ratio increased
• Secondary glycosuria
• Absence of significant ketoacidosis o Metabolic acidosis absent or mild

How Is Diabetic Coma Treated?
It is an emergency situation, and should be treated immediately. Patient should be hospitalised. Treatment goals are to treat hyperglycaemia with insulin and treat dehydration with intravenous fluids. Infection can be treated with antibiotics.

How to prevent diabetic coma?
Monitor and Check your blood glucose regularly, as recommended by your doctor Check your blood glucose every four hours when you are suffering from any infection. Take special care of yourself when you are having severe illness.