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Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a life-threatening condition when the body has practically no insulin. This insulin deficiency results in extremely high blood sugar levels. Consequently, the muscle, fat and liver cells cannot use glucose for fuel. These cells are converted into glucose by hormones such as glucagon and adrenalin and turned into ketones through oxidation. As a result, the body uses fat for fuel. The increased levels of blood sugar are not flushed through urination.

DKA is usually noticed in patients suffering from Insulin-dependent diabetes. A person can suffer from diabetic ketoacidosis if there has been severe dehydration and consequently the blood chemistry has been affected. There is accumulation of organic acids and ketones in the blood. Elevated ketone levels in the body upset its blood pH and make the blood acidic thereby triggering a toxic condition for the body's cells. Diabetic ketoacidosis is noticed when hyperglycemia exceeds 300 mg/dL. If diabetes ketoacidosis is not addressed in time, it can lead to coma and death. Surgery, infection, trauma, stroke or heart attack can also trigger diabetes ketoacidosis. Insufficient fluid intake, pancreatitis and alcohol abuse can trigger diabetes ketoacidosis.


Symptoms of diabetes ketoacidosis include excessive thirst and general weakness. There is frequent urination, loss of appetite and vomiting. Other symptoms of diabetes ketoacidosis are weight loss and abdominal pain. A person suffering from DKA tends to experience low blood pressure and increased heart rate. High ketone levels can give rise to a fruity-scent on the breath and vomiting. The patient will be restless and agitated. The skin will be hot and dry and appear flushed. Patients suffering from diabetes must check their blood glucose levels if they notice any symptoms of diabetes ketoacidosis. Poor diabetes management can lead to DKA.


Acidosis can be checked by testing the pH of the blood. Normal blood pH ranges from 7.35 to 7.45. If it is observed to be below 7.35, acidosis may have set in. Ketosis, acidosis and hyperglycemia can be diagnosed through blood tests. The patient will need fluid replacement till the body is sufficiently rehydrated. Electrolytes must also be suitably replaced as they are essential to the working of major organs and nerve cells. Electrolyte imbalance can lead to severe health hazards. Intravenous insulin aids in using up glucose for energy. Thus the breakdown of fat is stopped. Consequently acidosis and ketosis processes will be reversed.


Glucophage Metformin - Diabetic Drug

Glucophage is the brand name of the drug Metformin hydrochloride which is an oral antidiabetic medication. Metformin lowers the amount of sugar in the blood by decreasing sugar production and absorption by acting on the liver. It does not increase the body's production of insulin.

Type 2 diabetes has many treatment options as it appears to afflict people of many groups. Diabetes requires a change in life style and is best controlled by a measure of diet control and a regimen of exercises coupled with medications.
You may find more information about the diabetes diet in the Targetwoman collection of articles.

Metformin could cause a very rare and potentially fatal side effect known as lactic acidosis. It is caused by an excess of lactic acid in the blood. The problem is likely to occur in people with impaired liver or kidneys functions. Again this drug is contraindicated for patients with a history of cardiac problems. Lactic acidosis is a medical emergency that must be treated in a hospital. Metformin is contraindicated for patients with metabolic or Diabetic ketoacidosis - a life-threatening medical emergency caused by insufficient insulin and marked by excessive thirst, nausea, fatigue, pain below the breastbone and fruity breath. Diabetic ketoacidosis should be treated with insulin.


Side Effects of Metformin: Abdominal discomfort, diarrhea, gas, headache, indigestion, nausea, vomiting, general weakness though some patients rarely display symptoms like Abdominal distention, abnormal stools, altered sense of taste, constipation, dizziness and upper respiratory infection.

Dosage of Glucophage: Typically a starter dose is about 500 mg twice a day with meals. But a number of factors are taken into consideration before a doctor selects a dosage depending on the patient's condition. Glucophage XR is an extended release form and is prescribed as a single dose.


Neutrophilia

High levels of neutrophil in the blood results in neutrophilia; neutrophils are White Blood Cells or WBC that are assigned the task of killing/fighting off foreign matter like fungi and bacteria in the body. They are an important part of the body's defense force. An adequate amount of production and distribution of neutrophils is very important. However during an infection in the body, an elevated level of neutrophils can be found, with equal numbers in marginal and circulating pool.


The site of infection generates chemotactic agents and attracts neutrophils to the affected part. During recovery the flow of cells decreases from the marrow and this in turn decreases the amount of neutrophils. Neutrophilia is the most common form of leukocytosis - a condition wherein the blood has an increased number of leukocytes. When the cells shift from the marginal to circulating pool without an increase in the total blood granulocyte pool or if there is an increase in size of the TGBP, it could result in Neutrophilia.


Women in their childbearing age have a higher neutrophil count when compared to men. Pregnancy also leads to high neutrophil count and this may tend to increase during childbirth.


Neutrophilia occurrence

True Neutrophilia: True Neutrophilia occurs in most cases of infection and total blood granulocyte pool, the TGBP, may increase 5-6 times the normal level. At the onset of the infection, Neutrophilia count decreases and then it rises to very high levels.

Shift Neutrophilia: Shift Neutrophilia as the name indicates is transient (e.g. during heavy exercise) and may occur in association to other conditions. The change in numbers may last only for a few minutes. There is no change in the inflow of neutrophils from the bone marrow.


Causes for Neutrophilia

Neutrophilia is caused due to increase in bone marrow output or redistribution of white cells. Though there are numerous possibilities for an elevated level of neutrophils in the blood, the most common causes include:


  • Infections, caused by cocci, certain fungi, bacteria (local or generalized), viruses (chickenpox, herpes simplex) and parasites (hepatic amebiasis, Pneumocystis carinii) lead to Neutrophilia

  • Non-infectious inflammation like burns, post surgery, acute attack of gout, asthma, rheumatic fever, autoimmune conditions, any kind of trauma, tissue damage, myocardial infarction can also lead to Neutrophilia
  • Acute and sudden hemorrhage can lead to inflammation and thus lead to Neutrophilia.

  • Poisoning from sources like mercury, lead, digitalis, camphor, quinidine and certain insects can also lead to Neutrophilia

  • Metabolic changes in the body like diabetic ketoacidosis, uremia, etc can cause Neutrophilia

  • Malignancies and other kinds of spreading cancer, where the tumor outgrows the blood supply can lead to neutrophilia

  • Physiologic Neutrophilia is also caused by heavy exercise, epinephrine injections, etc

  • Other causes for Neutrophilia could include seizures, anemia, increase or decrease in platelet count, short or long term usage of corticosteroids, Cushing disease etc

  • Cigarette smoking can cause inflammation and thus lead to Neutrophilia.

  • High levels of stress can also lead to increase in levels of neutrophils and thus cause Neutrophilia.

  • Neutrophilia may be present without any particular cause that can be identified, this type of neutrophilia is called chronic idiopathic neutrophilia.

Diagnosis

Most often neutrophilia is a reactive phenomenon and can be diagnosed through blood tests. A physical examination is done and the medical history of the patient is studied. A complete blood count investigation and a series of blood tests are ordered for. In a few cases bone marrow aspiration is ordered for. The commons symptoms reported include decreased body temperature or hypothermia, dyspnea (labored breathing) or tachypnea (rapid breathing) and sometimes bleeding.


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Collection of Pages - Last revised Date: December 13, 2017