Hyperthyroidism is a condition in which the thyroid gland makes too much thyroid hormone. The condition is often referred to as an “overactive thyroid.”
By definition, DKA is characterized by the triad of
- Uncontrolled hyperglycemia (high blood glucose)
- Metabolic acidosis
- Increased total body ketone concentration
Causes and Risk Factors
DKA results from the combination of absolute or relative insulin deficiency and an increase in counter - regulatory hormones (glucagon, catecholamines, cortisol, and growth hormone). Most patients with DKA have type 1 diabetes; however, patients with type 2 diabetes are also at risk during the stress of acute illness such as trauma, surgery, or infections.
Common causes or precipitating factors
- Omission of insulin dose
- Inadequate insulin dose
- Infections
- Heart attack
- Stroke
- Use of drugs like steroids, anti - psychotic drugs, phenytoin, etc.
- Can be first manifestation of type 1 diabetes
- Previously blockage of continuous insulin pumps (unlikely with modern pumps)
When to suspect?
Usually occurs in the setting of uncontrolled blood glucose (the person might complain of history of polyuria, polydipsia and weight loss in the preceding days).
- Blood glucose is usually more than 250 mg/dL
- Infections in persons with type 1 diabetes
- Vomiting and abdominal pain
- Dehydration
- Rapid breathing
- Fruity odour in breath
- Extreme fatigue and drowsiness – can progress to coma
Common clinical features
- Low blood pressure
- Increased pulse rate
- Increased respiratory rate
- Dry skin and mouth
- Mental status can vary from full alertness to profound lethargy or coma.
Treatment
The goal of treatment is to correct the high blood sugar level with insulin. Another goal is to replace fluids lost through urination and vomiting.
- Insulin replacement
- Fluid and electrolyte replacement
- The cause of the condition (such as infection) will be found and treated
Someone with diabetes may be able to spot the early warning signs and make changes at home before the condition gets worse. It is important to stay in close touch with the doctor.
Early warning signs
Loss of appetite, nausea and vomiting, abdominal pain, fatigue
Early corrective changes at home (Only to be underatken in close consultation with the doctor)
- Check blood glucose with glucometer
- Check urine ketones with dip stick
- Increase water intake
- An additional dose of short acting insulin can be injected in consultation with the doctor