Diabetic ketoacidosis is one form of metabolic acidosis in humans. The others being lactic acidosis and acidosis due to renal failure. Also respiratory failure can lead to metabolic acidosis due to the accumulation of carbon dioxide (CO2) in the blood which can be converted to carbonic acid by the effect of the enzyme carbonic anhydrase. Diabetic ketoacidosis is also a metabolic disorder of glucose transport in the body tissues in which glucose is unable to penetrate to the cell due to the deficiency of the hormone insulin in the blood.
Usually insulin is required for the uptake of glucose by the body cells in order to be metabolized by the glycolytic pathway to generate energy rich ATP molecules. Glucose cannot enter the cell efficiently by the process of self diffusion due to the polar structure that glucose has. This polar structure is repelled by the hydrophobic phospholipid bilayer of the cellular membrane.
As a result of this disorder glucose begins to be accumulated in the blood causing hyperglycemia. As a result of the hyperglycemia glucose starts to appear in the urine due to its excessive filtration in the kidney glomeruli. The excessive amount of glucose that is filtered linger in the kidney tubules for a while causing an osmotic effect that starts to withdraw water to the urine in excessive amount.
As a result of this dehydration occurs due to the polyurea that is caused by the osmotic effect that glucose exerts in the kidney tubules. This symptom of polyurea and dehydration are prominent features of diabetes mellitus in general and of ketoacidosis in particular. As a result to the deficient metabolism of glucose in diabetic patients the body starts to search for other sources of cellular fuel in order to generate energy for the body.
An immediate source of fuel for the cell are fatty acids. Therefore degradation od fats in the body is accelerated in diabetic patients. Thus leading to the development of hyperlipidemia which is typical of diabetic patients. Fatty acids are hydrophobic molecules that can readily penetrate the phospholipid bilayer. They enter the cell by a mechanism that differs than that of glucose. Therefore fatty acids do not require insulin for their entry into the cell.
Therfore their utilization to generate energy for the body is convenient due to their easy way to enter the cell. Fatty acids oxidation in the liver in turn generate a lot of energy for the body in the form of ATP molecules. Also fatty acids metabolism generate ketones as part of its metabolic pathway. The presence of ketones in the body can be an evidence to the presence of diabetes in the affected individual.
also it can occur in people under starvation conditions in which the amount of glucose in the blood is extremely deficient so that the body starts to utilize fatty acids as the sole cellular fuel in the body to generate ATP molecules. These ketones can accumulate in the body of people undernourished or under starvation conditions. Ketones can also start to appear in the urine of affected individuals due to its filtration in the kidney nephrons. Thus imparting the urine smell like acetone. This can be in certain cases an indication to the presence of diabetes in undiagnosed people.
The acidosis that results due to diabetic ketoacidosis can be physiologically compensated by an increase in the respiration rate which can expel more carbon dioxide in exhalation from the lungs. In severe cases of diabetic ketoacidosis the administration of a base is required. In this case bicarbonate ions would be sufficient to balance the acidity of the blood. Diabetic ketoacidosis can be corrected by the administration of insulin intravenously which will lower the sugar level in the blood by promoting its entry into the cells.
Diabetic ketoacidosis is a common complication of type I diabetes mellitus in which there is dependency in diabetic patients on insulin supply intravenously. Also the polyurea that occurs in diabetic ketoacidosis can lead to dehydration. This symptom can lead to increased level of urea in the blood with possible development of acute kidney failure if the dehydration is persistent. The treatment in this case is to administer saline solution to the body. Also the electrolytes imbalance in the body must be corrected by administration of suitable solutions.