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During this lecture Professor Zach Murphy will be presenting on the differential diagnosis of diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar syndrome (HHS). These are the most common and life threatening acute complications from diabetes mellitus. Throughout the length of this lecture you will be able to learn the clinical presentations of DKA and HHS, how each condition is diagnosed, along with the treatment of these medical emergencies. We will be presenting on the most relevant concepts which will be delivered in a high yield format to compliment your studies. We hope you enjoy this lecture and be sure to support us below!

Kussmaul Breathing in 10 y/o DM-I: https://www.youtube.com/watch?v=TG0vpKae3Js&feature=youtu.be

Normal values pertinent to this lecture
1) Anion Gap: 3-10 mEQ/L
2) Serum Osmolality: 285-295 mOsm/kg
3) pH= 7.35-7.45
4) PaCO2: 35-45mmHg
5) HCO3-: 22-26 mEQ/L
Reference: CMDT

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Diabetic Ketoacidosis is a serious complication of type 1 diabetes that occurs when your blood sugar levels are extremely high and acidic substances called ketones grow to dangerous levels.

Side effects include (but aren’t limited to) extreme thirst, lethargy and weight loss.

Listen to Kate’s story about how she found out her 3 year old son was suffering from DKA and what to look out for in yourself or loved ones.

Remember to always seek medical advice from your GP if symptoms appear and find out more on our website https://www.diabetes.org.uk/guide-to-diabetes/complications/diabetic_ketoacidosis

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We are Diabetes UK. Our vision is a world where diabetes can do no harm.
We’re leading the fight against the UK’s biggest and growing health crisis. And it’s a fight that involves us all – sharing knowledge and taking on diabetes together.

Visit https://www.diabetes.org.uk/ to learn more about diabetes symptoms, prevention tips and more.
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Diabetic ketoacidosis (one of the hyperglycemic crises), DKA, pathophysiology, causes, clinical presentation (signs and symptoms) and treatment. This video is available for instant download licensing here: https://www.alilamedicalmedia.com/-/galleries/narrated-videos-by-topics/diabetes/-/medias/bda71a7a-4598-4b1d-b298-ed06b3c54238-diabetic-ketoacidosis-dka-narrated-animation
Voice by: Penelope Hammet
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Diabetic ketoacidosis, DKA, is an ACUTE and potentially life-threatening complication of diabetes mellitus. DKA is commonly associated with type 1 but type 2 diabetics are also susceptible. DKA is caused by a critically LOW INSULIN level and is usually triggered when diabetic patients undergo further STRESS, such as infections, inadequate insulin administration, or cardiovascular diseases. It may also occur as the FIRST presentation of diabetes in people who did NOT know they had diabetes and therefore did NOT have insulin treatment.
Glucose is the MAJOR energy source of the body. It comes from digestion of carbohydrates and is carried by the bloodstream to various organs. Insulin is a hormone produced by beta-cells of the pancreas and is responsible for DRIVING glucose INTO cells. When insulin is DEFICIENT, glucose can NOT enter the cells; it stays in the blood, causing HIGH blood sugar levels while the cells are STARVED. In response to this metabolic starvation, the body INcreases the levels of counter-regulatory hormones. These hormones have 2 major effects that are responsible for clinical presentation of DKA:
– First, they produce MORE glucose in an attempt to supply energy to the cells. This is done by breaking down glycogen into glucose, and synthesizing glucose from NON-carbohydrate substrates such as proteins and lipids. However, as the cells CANNOT use glucose, this response ONLY results in MORE sugar in the blood. As blood sugar level EXCEEDS the ability of the kidneys to reabsorb, it overflows into urine, taking water and electrolytes along with it in a process known as OSMOTIC DIURESIS. This results in large volumes of urine, dehydration and excessive thirst.
– Second, they activate lipolysis and fatty acid metabolism for ALTERNATIVE fuel. In the liver, metabolism of fatty acids as an alternative energy source produces KETONE bodies. One of these is acetone, a volatile substance that gives DKA patient’s breath a characteristic SWEET smell. Ketone bodies, unlike fatty acids, can cross the blood-brain barrier and therefore can serve as fuel for the brain during glucose starvation. They are, however, ACIDIC, and when produced in LARGE amounts, overwhelm the buffering capacity of blood plasma, resulting in metabolic ACIDOSIS. As the body tries to reduce blood acidity by EXHALING MORE carbon dioxide, a deep and labored breathing, known as Kussmaul breathing may result. Another compensation mechanism for high acidity MOVES hydrogen ions INTO cells in exchange for potassium. This leads to INcreased potassium levels in the blood; but as potassium is constantly excreted in urine during osmotic diuresis, the overall potassium level in the body is eventually depleted. A blood test MAY indicate too much potassium, or hyperkalemia, but once INSULIN treatment starts, potassium moves BACK into cells and hypokalemia may result instead. For this reason, blood potassium level is monitored throughout treatment and potassium replacement is usually required together with intravenous fluid and insulin as primary treatment for DKA.
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(USMLE topics) What is Gestational Diabetes? Pathology, Risk factors, Complications and Treatments. This video is available for instant download licensing here : https://www.alilamedicalmedia.com/-/galleries/narrated-videos-by-topics/common-ob-gyn-problems/-/medias/257bea34-3735-471b-86d3-d514baa666e8-gestational-diabetes-narrated-animation
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Gestational diabetes is a transient form of diabetes mellitus some women may acquire during pregnancy. Diabetes refers to high levels of blood glucose, commonly known as blood sugar. Glucose is the major energy source of the body. It comes from digestion of carbohydrates and is carried by the bloodstream to the body’s cells. But glucose cannot enter the cells on its own; to do so, it requires assistance from a hormone produced by the pancreas called insulin. Insulin induces the cells to take up glucose, thereby removing it from the blood. Diabetes happens when insulin is either deficient or not used effectively. Without insulin, glucose cannot enter the cells; it stays in the blood, causing high blood sugar levels.
During pregnancy, a temporary organ develops to connect the mother and the fetus, called the placenta. The placenta supplies the fetus with nutrients and oxygen, as well as produces a number of hormones that work to maintain pregnancy. Some of these hormones impair the action of insulin, making it less effective. This insulin-counteracting effect usually begins at about 20 to 24 weeks of pregnancy. The effect intensifies as the placenta grows larger, and becomes most prominent in the last couple of months. Usually, the pancreas is able to adjust by producing more insulin, but in some cases, the amount of placental hormones may become too overwhelming for the pancreas to compensate, and gestational diabetes results.
Any woman can develop gestational diabetes, but those who are overweight or have family or personal history of diabetes or prediabetes are at higher risks. Other risk factors include age, and having previously given birth to large babies.
While gestational diabetes usually resolves on its own after delivery, complications may arise if the condition is severe and/or poorly managed.
Because of the constant high glucose levels in the mother’s blood, the fetus may receive too much nutrients and grow too large, complicating the birth process, and a C-section may be needed for delivery.
High levels of glucose also stimulate the baby’s pancreas to produce more insulin than usual. Shortly after delivery, as the baby continues to have high insulin levels but no longer receives sugar from the mother, the baby’s blood sugar levels can drop suddenly and become exceedingly low, causing seizures. The newborn’s blood sugar level must therefore be monitored and corrected with prompt feeding, or if necessary, with intravenous glucose.
High blood sugar may also increase the mother’s blood pressure and risks of preterm birth. Future diabetes in both mother and child is also more likely to occur.
Gestational diabetes can be successfully managed, or even prevented, with healthy diets, physical exercise, and by keeping a healthy weight before and during pregnancy. In some cases, however, medication or insulin injection may be needed.
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What is diabetes mellitus? Diabetes mellitus is when there’s too much glucose, a type of sugar, in the blood. Diabetes mellitus can be split into type 1, type 2, as well as a couple other subtypes, including gestational diabetes and drug-induced diabetes.

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