Diabetic ketoacidosis is a medical emergency.

It is more common and marked in type 1 diabetes.

Rarely occurs in  type 2 diabetes.

Usually seen in previously undiagnosed Diabetes Mellitus.

It is associated with severe medical conditions etc MI, Septicemia.

Precipitating Condition

• Infection like UTI, Sepsis, Pneumonia
• Infarction
• Severe stress
• Hyperthyroidism
• Drug- Thiazide, corticosteroid
• Pregnancy

Symptom

• Polyuria
• Weight loss 
• Nausea, vomiting
• Thirsty
• Weakness
• Polydipsia
• Leg cramps
• Blurred vision
• Abdominal Pain

Sign

• Dehydration
• Hypotension
• Smell of acetone
• Drowsiness
• Cold extremities
• Hypothermia
• Coma
• Confusion
• Cyanosis
• Tachycardia
• Shortness of breath
• Kussmaul breathing (air hunger)

Investigation

1. Urine examination- show Glucose and ketone
2. Plasma level- glucose level and ketone bodies raised
3. serum electrolyte

Potassium level- normal and raised

Sodium level- low

Bicarbonate- low

Phosphorus level- high

4. ECG- MI

5. Infection screen- blood count, urine culture.

Management

1. Fluide replacement- o.9% saline (NACL) administer.
2. Insulin- 50 miu soluble insulin

In 50 ml 0.9% saline

3. Potassium- none in 1st L of iv fluide unless plasma k 

K < 3.0 mmol/l 

When plasma protein 3.5-5 mmol/l give 10 mmol/ hr

4. Additional Procedures

Catherisation if no urine passed after 3 hours.

ECG monitoring in severe case

Antibiotics if  infection

Plasma expander if systolic B.P< 90 mmHg

5. Nasogastric tube- to keep stomach empty in uncovering and semiconscious patient.

Complications of Diabetic ketoacidosis

Acute respiratory distress syndrome

Acute circulatory failure

Thromboembolism

Cerebral Oedema

Homoeopathic medicine for Diabetic ketoacidosis

1. Carbo Veg
2. Syzygium Jambolanum
3. Gymnema Sylvestre
4. Acid phosphoricum
5. Uranium nitricum
6. Glycerinum 

Carbo Veg

It is very important remedy for Diabetic ketoacidosis.

The patient may be almost lifeless.

Coldness

Pulse imperceptible

Oppressed and quickened respiration.

Must have air.

Must be fanned hard.

Must have all the windows open.

This is the typical stage of  carbo veg.

The patient faint easily, is worn out, and must have fresh air.

Patient is very debilitated.

Limbs cold.

Patient seems to be too weak to hold out.

Syzygium Jambolanum

It is helpful remedy to prevention the case of diabetic ketoacidosis.

It is the one of the most important remedy for Diabetes

It has immediate effect of increasing the blood sugar level, glycosuria results.

No other remedy causes in so marked degree the diminution and disappearance of sugar in the urine.

Great thirsts, weakness, emaciation.

Very large amount of urine specific gravity high.

It is also useful in diabetic ulcer.

Acid phosphoricum

The most common debility is very marked in this remedy, producing a nervous exhaustion.

Frequent, profuse, watery, Milky.

It is very useful medicine for Diabetic ketoacidosis.

Micturition preceded by anxiety and followed by burning.

Frequent urination at night.

Uranium nitricum

Causes glycosuria and increased urine.

Is known to produce nephritis, Diabetes, degeneration of liver, high blood pressure and dropsy.

Its therapeutic keynote is great emaciation, debility and tendency to ascites and general dropsy.

Copious urination.

Diuresis.

Incontinence of urine.

Emaciation.

Burning in urethra, with very acid urine.

Glycerinum

Profuse urination

Increased specific gravity of urine and sugar.

It is highly effective remedy for Diabetic ketoacidosis.

Debility physically and mentally.