00:01
So ketosis and ketoacidosis
is a question I always get.
00:06
Some people are looking
for dietary ketosis.
00:08
They're doing what we
call the keto diet,
and people ask me, hey,
is that the same as diabetic ketoacidosis?
No, it's not.
00:16
So let me give you
a quick breakdown
in case you get this
question from your clients
or maybe you're interested
in knowing for your own self.
00:24
So ketosis is a normal
metabolic state.
00:27
Your numbers run about 1
to 6 ketones in the blood.
00:31
Now this means your body
is burning fat as energy
and it actually can do
that pretty efficiently.
00:38
That is different than
somebody who's in ketoacidosis.
00:43
Now, this is a dangerous
metabolic state.
00:46
Look how much higher
the ketones are.
00:48
Yeah instead of
ketosis being 1 to 6,
now in ketoacidosis,
it's 15 to 30.
00:55
That's the level of
ketones in the blood.
00:58
This is what happens
to type 1 diabetes.
01:01
If you hear someone say a keto diet is
like what a diabetic client goes through
that is not correct at all.
01:08
Usually people
following the keto diet
do have insulin in their bodies
and things are functioning
but they're just trying
a different method
or a way to furnish
their body with fuel.
01:18
Diabetic ketoacidosis is a
dangerous metabolic state.
01:24
Well, I bet you didn't expect this to
happen in the middle of our video, right?
A nice couch with comfy pillows.
01:29
Well, that's because this
is my couch of homeostasis.
01:33
You may remember this
from our ABG series,
but right in the middle,
that's where the couch
is the most comfortable
and so is your body.
01:41
So I use that middle portion
of the couch to represent a pH
of 7.35 to 7.45.
01:49
Now remember we get the pH through
arterial blood gases or ABGs
but I wanted you to have another
visual picture to remember
metabolic acidosis is dangerous
imbalance for your patient.
02:03
Well, what is the connection
to metabolic acidosis and DKA?
Well DKA is a cause of
being in metabolic acidosis.
02:14
Renal failure is a cause of
being in metabolic acidosis.
02:18
So I want you to know that
DKA is just as dangerous
as if we have somebody
in renal failure.
02:25
Now when we talk about the
pH you've got blue pillow,
you've got red pillows,
What does that all mean?
And that's just to help
you think about the couch
as a continuum.
02:35
So normal pH in the
middle is 7.35 to 7.45.
02:40
You might even want to
write that in on your notes.
02:43
If the patient's pH the numbers
are getting higher, right?
You're moving toward
that blue pillow,
there inching towards
7.45 or beyond,
the pH of their blood is
becoming more alkalotic.
02:56
If their pH of their blood
and remember we get this from
an arterial blood gas or an ABG
if it's getting lower,
it's moving towards 7.35 and even lower
the pH of the blood is
becoming more acidotic.
03:11
What we're talking
about today with DKA,
is definitely metabolic acidosis
as is renal failure.
03:19
In fact, these are the two most
common causes of metabolic acidosis
that you're likely to
see in your career.
03:26
So you got this solid
metabolic acidosis is no bueno.
03:31
It is not good really
hard on your body.
03:35
DKA and renal failure are
two ways your body gets
thrown off the couch
of homeostasis.
03:43
Now burning fat for
fuel can have a price
and keep in mind I'm not
talking about ketosis.
03:49
I'm talking about
diabetic ketoacidosis
for these patients fat
is not the best choice
for a primary energy sourcing.
03:57
So for type 1 diabetics,
fat is not the most efficient
fuel source for them
because he without insulin to
move glucose into their cells
out of the bloodstream
and into the cells,
the body turns to fat
stores for energy.
04:12
Now we end up with ketones that
are a byproduct of fat metabolism.
04:16
But remember, this level of ketones
in their blood is much higher
than if someone was
on a ketosis diet.
04:24
Okay,
so that's why it's different.
04:26
I know you keep
hearing me repeat that
but I want to make
sure you're very clear
because this is a fairly
popular diet plan right now,
and I want you to be able to
speak intelligently to it.
04:37
So these ketones come
when a type 1 diabetic
breaks down fat for energy there
a byproduct of fat metabolism
and ketones are acid.
04:47
So ketones
are byproducts of
fat breaking down.
04:51
Ketones are acidic,
so the more fat the patient's
body has to break down for energy
as a type 1 diabetic,
the more acidic
their pH will come.
05:03
Make sense?
That's why somebody with DKA
has a much higher
level of ketones
than someone who's
just doing a keto diet.
05:12
Excessive ketones
equals ketoacidosis
because ketones are acidic
the more of them you have,
the more significant the
impact on the blood pH.
05:24
Now excessive ketones also
equals severe dehydration.
05:28
See that pH is turd
and it becomes acidic
and it puts the patient
in metabolic acidosis.
05:35
So we've got all the
ketones there for you
just to kind of give you
a visual to remember.
05:39
Hey, the higher ketones get the more
dehydrated the patient will get.
05:44
Now the electrolytes
also severely depleted
because they're trying
to restore balance
from this off balance ketosis.
05:51
So in addition in DKA not
just their blood sugar is off
but also their electrolytes
can be severely off.
05:58
So we're going to look for
imbalances in all of these.
06:01
You don't need me to read you this
list, but take a look at that.
06:05
These are really life
important right there,
talking about fluid balance and how
the electricity of my heart works
and we're balancing the
pH of my bloodstream.
06:14
Yeah.
06:15
These are all really
important in electrolytes
and controlling my
life and my body health
so patients in DKA, we not only deal
with keeping their blood sugar normal,
but we're also watching for normal
values in these electrolytes.
06:34
Now a patient with
ketones in their urine
and their blood is most likely
experiencing HHS or DKA?
See if you can test
your knowledge.
06:43
So if a patient has ketones
in their urine in their blood
are they most likely
experiencing HHS or dka?
Okay well, that's a flip a
coin kind of answer right.
06:55
Now I want you to see
if you can explain why.
06:57
Pause the video for a second and
see if you can walk back through it
we've talked about to
support your answer.
07:04
Okay, welcome back.
07:07
DKA is a profound
absence of insulin,
fat is the primary
energy source.
07:13
So ketones are a byproduct
of the fat metabolism.
07:16
So this patient is in DKA.
07:19
Remember HHS patients
have just enough insulin
to ward off dka.
07:26
So good job
If you got it, very impressed.
07:29
If you didn't no problem,
just add a special
note to yourself
and your notes and you
will get it next time.