According to the World Health Organization, about 8.8% of the world population (425 million people) is diabetic and approximately 10% of diabetes cases are classified as type I, which is characterized by a deficiency in insulin secretion due to destruction β-pancreatic cells.

One of the main complications of untreated diabetes mellitus is diabetic ketoacidosis. In this case, insulin deficiency prevents the uptake of glucose by the body's cells, generating an intracellular energy deficit and an accumulation of glucose in the blood. As a consequence, there is an increase in the concentration of anti-regulatory hormones that activate the breakdown of adipose tissue molecules for use as an energy source.

The use of fat molecules as an energy source results in the formation of ketone bodies, which are responsible for the characteristic breath observed in diabetic patients or in people who fast for a long time. Some of the ketone bodies are acidic molecules, which leads to acidosis by lowering blood pH.

At this stage there is an electrolyte imbalance in the body. Potassium ions, predominantly intracellular, begin to be released into the bloodstream due to the absence of insulin. In parallel, bicarbonate ions are consumed in an attempt to buffer the ketone bodies and maintain blood pH. The excess of metabolites in the blood causes the extracellular medium to become hypertonic, causing the loss of water from inside the cells and further increasing the loss of intracellular potassium.

Adapted from: https://www.nipro-group.com/en-en/inspire/diabetic-ketoacidosis-dka-why-should-it-matter-me

Excess potassium in the blood is known as hyperkalaemia. This condition alters the electrical potential of heart cells, causing cardiac arrhythmias that can be fatal.

The diagnosis of diabetic ketoacidosis is based on the triad of hyperglycemia, ketosis and metabolic acidosis. To support this diagnosis, the measurement of blood glucose, β-hydroxybutyrate (one of the types of ketone bodies) and bicarbonate is essential. The diagnosis can be even more relevant when associated with the measurement of glycated hemoglobin or fructosamine, both long-term glycemic markers.

Biotécnica, always at the service of life, has diagnostic kits in vitro for the measurement of electrolytes, glucose and glycated hemoglobin, assisting in the diagnosis of diabetic ketoacidosis. In addition, it is increasing its portfolio with the inclusion, for example, of the kit for the determination of β-hydroxybutyrate, so that, increasingly, it can provide greater and better assistance for the diagnosis of various diseases.

FERNANDA REBELLATO GIORDANO MARTIM
Biotécnica Ind. E Com. Ltda
www.biotecnica.ind.br
+55 (35) 3214-4646

References:

Parham, WA et al. Hyperkalemia revisited. Texas Heart Institute Journal. 2006; v. 33 (1), p. 40.

Dhatariya, KK et al. Diabetic ketoacidosis. Nature Reviews Disease Primers. 2020, v. 6, p. 40.

Balcı AK et al. General characteristics of patients with electrolyte imbalance admitted to emergency department. World Journal of Emergency Medicine. 2013; v. 4 (2), p.113.