Hello and welcome to the Zero to Finals podcast.

My name is Tom and in this episode I'm going to be talking to you about diabetic ketoacidosis.

And if you want to follow along with written notes on this topic, you can follow along at

zero definals.com slash dka or in the endocrinology section of the zero definals pediatrics book.

So let's get straight into it.

Diabetic ketoacidosis is a life-threatening medical emergency,

and it's the most common way that children with a new diagnosis of type 1 diabetes will

present.

Firstly, we need to talk about the process of ketogenesis, or the creation of ketones.

Ketogenesis normally occurs when there's an insufficient supply of glucose, and the glycogen

stores in the muscles and the liver are exhausted.

And this may happen after a prolonged period of fasting or with very low carbohydrate

diets. The liver takes fatty acids and converts them into ketones and ketones are soluble fatty acids

that can be used as fuel. Ketones can cross the blood-brain barrier and be used by the brain

as fuel.

And producing ketones is normal and not harmful in otherwise healthy patients

under fasting conditions or on a very low carbohydrate, high-fat diet.

Ketone levels can be measured in the urine using a urine dipstick and also in the blood using a ketone

meter. And people in ketosis have a characteristic acetone smell to their breath. Ketone acids,

or ketones, are buffered in normal patients, so the blood does not become acidic. When underlying pathology such as type 1 diabetes

causes extreme hyperglycemic ketosis,

this results in a metabolic acidosis that is life-threatening.

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