ليهسة أتذكر بالباطنية مال الرابع بسشنات النيورو، انسألت على الـ UMN lesions وما عرفت الجواب... واني قبلها بسنة بالضبط شارحها هنا :")

المهم...

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Within 10 years of developing overt symptoms of diabetic autonomic neuropathy, 30–50% of patients are dead, many from sudden cardiorespiratory arrest. Patients with postural hypotension (a drop in systolic pressure of 30 mmHg or more on standing from the supine position) have the highest subsequent mortality.

Basic principles of potassium homeostasis:

This brings me to "Hypokalemia in DKA"

Every patient in DKA is potassium-depleted but the plasma concentration of potassium gives very little indication of the total body deficit. Plasma potassium may even be raised initially due to disproportionate loss of water, and displacement of potassium from the intracellular compartment by H+ ions.

Soon after treatment is started, there is likely to be a precipitous fall in the plasma potassium due to dilution of extracellular potassium by administration of intravenous fluids, the movement of potassium into cells induced by insulin, and the continuing renal loss of potassium.

Me when a DKA patient presents with hyperkalemia but actually has hypokalemia:

A cross-sectional analysis found that vegans had the highest concentrations of uric acid followed by meat eaters, and that fish eaters and vegetarians had the lowest uric acid concentrations. These differences by diet groups were more pronounced in men than in women.

The higher uric acid concentrations among vegans might be due to their lack of consumption of dairy products, which are thought to lower uric acid concentrations. Also, the low calcium content of the vegan diet might contribute to higher uric acid concentrations.

Limb embryology

In the fulminating case of DKA, the striking features are those of salt and water depletion, with loss of skin turgor, furred tongue and cracked lips, tachycardia, hypotension and reduced intra-ocular pressure. Breathing may be deep and sighing (Kussmaul’s sign), the breath is usually fetid, and the sickly-sweet smell of acetone may be apparent. Mental apathy, delirium or a reduced conscious level may be present, although coma is uncommon. Indeed, a patient with dangerous ketoacidosis requiring urgent treatment may walk into the consulting room. For this reason, the term ‘diabetic ketoacidosis’ is to be preferred to ‘diabetic coma’, which implies that there is no urgency until unconsciousness supervenes. In fact, it is imperative that energetic treatment is started at the earliest possible stage.

Abdominal pain is sometimes a feature of DKA, particularly in children, and vomiting is common. Serum amylase may be elevated but rarely indicates coexisting pancreatitis.

الـ serum amylase هذا متفتهم شنو سالفته
ما نعرف لحد الآن ليش يصعد وية الـ DKA بس ممكن تشوف 50% من مرضى الـ DKA عدهم مرتفع.