PATHOPHYSIOLOGY OF DIABETIC KETOACIDOSIS and HYPERGLYCEMIC

HYPEROSMOLAR NONKETOTIC SYNDROME

Etiology:
1.Infection
2. inadequate insulin administration, or
cardiovascular diseases

Critically low insulin level

No promotion of membrane trafficking of

the glucose rtansporter GLUT4 from
GLUT 4 storage vesicles to the plasma
membrance

Glucose cannot enter the intracellular

fluid compartment

Glucose stays in the intravascular

compartment (blood circulation)

Cells are deprived of fuel and energy and

so becomes starved

Hyperglycemic Hyperosmolar Nonketotic

Diabetic Ketoacidosis (Type 1)
Syndrome (Type II)
Body responds by increasing the levels of
counter-regulatory hormones such as
catecholamines, cortisol, glucagon, and
growth hormone

In an attempt to supply energy cells, this These hormones activate lipolysis and
hormone increases hepatic and renal fatty acid metabolism for alternative fuel
glucose production

Liver breaks Metabolism of fatty acids as an

Kidneys stimulate alternative energy source produces ketone
down glycogen
gluconeogenesis bodies (such as acetone)
into glucose

Ketone bodies, which Fruity odor breath

are acidic, pass and
Further hyperglycemia
through the blood ketones can be
brain barrier which excreted in the urine
then fuel the brain (Ketonuria)
cells
Renal threshold for glucose reabsorption
When produced in large amounts,
Glucose overflow into the urine overwhelm the buffering capacity of
 PATHOPHYSIOLOGY OF DIABETIC KETOACIDOSIS and HYPERGLYCEMIC
HYPEROSMOLAR NONKETOTIC SYNDROME

Osmotic diuresis
(increased urination rate)
Metabolic Acidosis

Polyuria
(Increased frequency of urination and Body compensates by increasing
excessive amount of urine) ventilation to reduce carbon dioxide
(acid) in the body

Moves hydrogen Kussmaul

Dehydration ions into cells in breathing
(less water in Polydipsia exchange for (labored and
blood, more potassium deep)
sodium &
glucose)

Moves hydrogen ions into

cells in exchange for
potassium
Increased concentration of
solutes in the blood

Increased potassium levels

Increased osmolality
(Hyperosmolality) However, potassium is
constantly excreted in urine
during osmotic diuresis,
the overall potassium level
in the body is eventually
depleted