Hello everybody my name is Dr. Ferox
And thanks for joining me on this little, very simplified rant about the glorious metabolic catastrophe that is diabetic ketoacidosis
or DKA for short
you would all know that in a normal animal the glucose that you eat goes into the cells where it's turned into energy with the
help of our friend of insulin
In a diabetic they don't produce enough insulin on their own which is fine
So we inject it, and then they live a more or less normal life
but in a DKA
For whatever reason they've been under dosed on insulin
Maybe they're stressed, maybe they're sick. It doesn't really matter why the resulting catastrophe is basically the same
Without insulin, glucose does not get into your cells except by passive diffusion
Which is just not adequate and your cells are starving so they try and stay alive by metabolizing fats
Which works, but the fats produce acidic compounds and ketones
The acid on its own is a huge problem because acids denature proteins, and our friend insulin is a protein
So when the acidity of the blood increases insulin becomes less functional
if they [the patient] had any to start with and then everything gets worse very, very quickly
Acidification of the body on its own is one way that these patients can die
Acids cause proteins to denature
Which is the same sort of process you get if you take a steak and you marinate it in lemon juice:
It goes brown and soft and it changes, and that is not conducive to being alive
Now once you have them in the clinic and you start treating these poor cases you need to give them lots and lots of fluids
And you need to get them on to some effective insulin therapy
The amount of insulin you need varies depending on the patient
And how sick they've been and for how long and whatever else is going on
But you give them enough insulin to get their blood glucose levels to drop to normal which puts glucose
Back into the cell where it can do its job
And when glucose enters the cell it drags its friend potassium with it
And, a lot of these patients will drag a lot of potassium in with them into the cells which means the potassium in your blood
Ends up going through the floor and that can cause your heart to stop, so, that's another way they like to die
Fortunately, we can add lots of potassium to the intravenous fluids
But if you add too much too quickly it will also cause the heart to stop and that's obviously not good
But doesn't quite end there
At least now we've got glucose in our cell which is where our cell wants it to be
So that it can make energy; and on a cellular level that means turning a molecule called ADP, which has two, phosphorouses
Into ATP
Which has three phosphorouses
Which means you suddenly have a lot less
phosphorous floating around
Now you might not know what phosphorous does, but when you have too much or too little of it all your red blood cells
explode
in an acute hemolytic crisis
and
They [the patient] can die
this is why sometimes our diabetics need blood transfusions when everything has really hit this catastrophic point
So keeping these patients alive in the vet clinic is sometimes a real challenge, but when you pull it off. It just works
It's like magic because so much is going wrong and there is so much you can do to fix them
It does mean we need to monitor them every couple of hours
We need to know what their acid base is doing what their glucose is doing what their potassium is doing what their phosphorous is doing
And also what their PCV is doing which measures their red blood cell concentration
Because all of these things can go wrong and they can all go wrong very very quickly, but you can fix them it just takes
well quite a lot of effort, but
It's really good medicine when it works
It's really, really fun when you get it right, and you see something that was trying very, very hard to die
Just turn around and go back to being what it's supposed to be
So that my friends, is the very, very simple version of diabetic ketoacidosis
Thanks for listening, and I will catch you next time