Ketoacidosis

The ketoacidosis is a form of metabolic acidosis, the most frequently occurs as a complication of diabetes mellitus in absolute insulin deficiency. The reason is a too high concentration of ketone bodies in the blood.

Causes and development

In the development of ketoacidosis, the organic acids acetoacetic acid and β - hydroxybutyrate ( ketone bodies ) in the blood accumulate and reduce its pH, caused by a long-lasting absolute insulin deficiency. Mild forms of ketoacidosis occur even during prolonged fasting (hunger, fasting) through the increased fat and protein breakdown for energy.

The lack of insulin in turn then leads to that in the liver where more fat is broken down, thereby increasing acetyl -CoA is formed from the turn acetoacetate, the salt of acetoacetic acid is formed ( acetoacetate is the " hunger metabolism " under physiological conditions after a further metabolic step as an energy supplier in the tissue ).

The most common is the catabolic situation in insulin deficiency in the context of a derailed diabetes mellitus cause (diabetic ketoacidosis ) for this accumulation of organic acids in the blood. Another typical cause is considered the massive increase in β -hydroxybutyric acid in the blood as a result of alcohol consumption (alcoholic ketoacidosis ) (alcohol inhibits gluconeogenesis and oxidation of free fatty acids in the liver). Even genetic diseases such as congenital deficiency of succinyl -CoA Acetoacetate transferase ( SCOT syndrome) may be triggering.

Clinical appearance

The ketoacidosis presents clinically by nonspecific symptoms such as vomiting, polyuria, thirst and weakness. In the further course of the disease is it, then clouding up to the loss of consciousness, the Kussmaul breathing with acetone odor of breath and dehydration ( dehydration ). The disease if not treated fatal.

Investigation

(→ Main article metabolic acidosis)

Emergency Medical give history, clinical appearance, a frequent acetone odor of breath valuable information.

Groundbreaking study under steady state conditions is the blood gas analysis (pH < 7.25, decreased pCO2, HCO3 < 15 mmol / l and negative BE). In diabetic ketoacidosis induced there is a significantly elevated blood sugar levels in the alcoholic he can be both reduced and increased normal or slightly.

Treatment

Therapeutically are the completion of the causal, catabolic action by the administration of insulin as well as adequate hydration due to the accompanying dehydration in the foreground. In addition to general emergency or intensive care measures to maintain the vital functions is to recognize other potentially life-threatening changes early enough, can a consistent biological monitoring of those affected necessary. In particular, significant deviations of blood glucose and potassium levels in the blood during the early phase often require prompt intervention.