BIOCHEMISTRY

FIRST YEAR

DIABETIC ACIDOSIS

Group Members:
'ABDULLAH 'AZAM BIN KHAIRUDDIN
AHMAD LUQMAAN BIN BAHARUDIN

5001
5006

MUHAMMAD IHSAN BIN ABDUL HALIM

5045

MUHAMMAD IKRAAM BIN ABDUL LATIF

5046

MUHAMMAD SYUKRI BIN ABD RAUF

5052

Introduction

Alhamdulillah, praise be to Allah the Most Gracious and the Most merciful,
Who has given us the chance to present a project work in biochemistry for this year.
In this project work, we will explain about a known disease, which is diabetic
acidosis or diabetic ketoacidosis (DKA). This disease has been discovered for
centuries, and definitely we will share with the readers a brief idea about this
particular disease, its causes, signs & symptoms, and also the possible treatments.
In addition, we would like to express our highest gratitude and appreciation to
the Kasr El-Ainy's Biochemistry Department for providing us the chance to produce

this project work. And thousands of thanks to all parties whether they are involved
directly or indirectly in the efforts of producing this project work.

Diabetic Acidosis
Diabetic acidosis or diabetic ketoacidosis (DKA) is an acute, major life-threatening
complication of diabetes. DKA mainly occurs in patients with type 1 diabetes, but it
is not uncommon in some patients with type 2 diabetes.

Overview
DKA is a serious complication of diabetes that occurs when our body produce very
high level of blood acids called ketones. Ketoses are one of branches of
carbohydrate other than aldehydes that contain ketone bodies. Ketones are
breakdown products from uses of fat stores for energy. It is a life-threatening
condition that can occur in people with type 1 diabetes and less commonly it can
also occur with type 2 diabetes.

DKA occurs when you have too little insulin in your body. Insulin normally plays a
key role in helping sugar (glucose) (C6H12O6) that is a major source of energy for
muscle and other tissues change to glycogen to reduce blood sugar level. So
without enough insulin, our body begins to breaks down fat as an alternative to get
glucose (C6H12O6) an energy. In turn, this process produce toxic acids in the
bloodstream called ketones that eventually leading to diabetic acidosis if untreated.
Biochemically, DKA is defined as an increase in the serum concentration of ketones
greater than 5 mEq/L, a blood glucose level greater than 250 mg/dL, and a blood
(usually arterial) pH less than 7.3.

Causes
DKA may be the first presentation in someone who had not previously been known
to be diabetic, but most regularly occurs in those
who already have diabetes. Mainly the cause of
DKA is the inadequate amount of insulin in our
body.

And there is usually a particular underlying

problem that has led to the DKA occurrence; this
may be intercurrent illness (pneumonia, influenza,
gastroenteritis, a urinary tract infection),
pregnancy, insufficient insulin administration,
myocardial infarction (heart attack), stroke or the
Insufficient insulin administration can
lead to diabetic ketoacidosis.

use of cocaine. Young patients with recurrent episodes of DKA may have an
underlying eating disorder, or may be using insufficient insulin for fear that it will
cause weight gain. In 5% of cases, no cause for the DKA occurrence is found.

What are the symptoms?

Since diabetic acidosis is most often linked with high blood sugar levels, symptoms
are the same as those for
diabetes but much more
severe:
increased thirst and
urination
tiredness
confusion
Fatigue
Headache
Muscle stiffness or aches
Decreased appetite

 possible loss of consciousness when blood sugar levels become very high
(diabetic coma).

Symptoms of acidosis are:

fast, deep breathing
Dry skin and mouth

a smell of acetone (fruity) on your breath

nausea and vomiting

stomach pains

Diagnosis
Diabetic ketoacidosis may be diagnosed when the combination of:

hyperglycemia (high blood sugars)

ketones in the blood or on urinalysis

acidosis are demonstrated

The Ketonuria (daily measurement of the concentration of

Ketones in the urine)

Mechanism

The lack of
insulin and
corresponding
elevation of
glucagon leads
to increased
release of
glucose
(C6H12O6) by the

A diagram about the general mechanism of

diabetic ketoacidosis.

liver (a process that is normally suppressed by insulin) from glycogen and

through gluconeogenesis .

Gluconeogenesis, a process of generating glucose (C6H12O6) from noncarbohydrate carbon substrate.

The

Glycogenolysis occurs in diabetic ketoacidosis which increases blood

glucose level.

absence of insulin also leads to the release of free fatty acids from adipose
tissue , which are converted, again in the liver, into ketone bodies (acetoacetate
and -hydroxybutyrate ).

The process of ketogenesis from fatty acids (hydroxybutyrate ) and explanation why smell of
acetone from mouth is possible

-Hydroxybutyrate can serve as an energy source in absence of insulin-mediated

glucose delivery, and is a protective mechanism in case of starvation. The ketone
bodies, however, have a low pKa and therefore turn the blood acidic (metabolic
acidosis ).

-hydroxybutyrate, despite chemically not

actually being a ketone, is the major
"ketone body" in diabetic ketoacidosis.

Physiological Response
Usually, the body attempts to reduce the level of acid by increasing the rate and
depth of breathing. This blows off carbon dioxide in the breath, which tends to treat
acidosis temporarily. At the same time, the high secretion of glucose (C6H12O6) into
the urine cause large quantities of water and salts to be lost, putting the body at

serious risk of dehydration. Eventually, over-breathing becomes inadequate to

control the acidosis.

Treatments
There are some goals of treatment of diabetic acidosis. It is to correct the
high blood sugar level. Another goal are to replace fluids lost through
urination and vomiting and to neutralize again the low pH acidosis in the
body.
Some people think that exercise can

help with the symptoms of diabetic

acidosis because it can help with diabetes. In fact, exercise actually make
thing worse. It will increase the level of acid in our body due to metabolic
product of exercise such as lactic acid. As we know, diabetic acidosis is
caused by low insulin level and so it must be treated with insulin.
So one of the treatment is give intravenous insulin into the patient. Patient
also need to get intravenous fluids to prevent dehydration due to ketones in the
urine. Another treatment is electrolyte replacement to change the pH of the body
to normal. The ions that important for treat this type of disease are potassium (K)
and bicarbonate (HCO3).

Conclusion

The
introduction
of diabetes

Intravenous fluids are important for preventing

dehydration.

educational programs in most diabetes clinics has contributed to a reduction

in the occurrence of diabetic ketoacidosis (DKA) in patients with known
diabetes. Such programs teach patients how to avoid DKA by self-testing for
urinary ketones and adjusting their insulin treatments on sick days.
It is important to educate patients in the prevention of diabetic ketoacidosis
(DKA) so that a recurrent occurrence can be avoided. Most crucial to patient
education programs for adults with diabetes is instruction on the selfmanagement process and on how to handle the stress of intercurrent illness.
The patient education program needs to ensure that patients understand the
importance of close and careful monitoring of blood glucose levels,
particularly during infection, trauma, and other periods of stress.
Lastly, we hope that from our project work, the society can learn something
so that they can lead themselves to a better health in future, insha-Allah.