I have blogged about DKA before.
DKA – diabetes keto acidosis. Starving in the sea of plenty. Too much sugar – way too much in the blood stream and not enough insulin to get it – the glucose into the cell. Did you ever do those experiments at school about osmosis, where water moves through a membrane to where it is being drawn? In this case the cells, so to speak, dehydrate and start to die and the vascular system is “loaded” with glucose. The cells are dry dry dry and have no way of doing what they need to do – metabolism – without which the human whose cells they are die.
A process begins and catapults quickly and rapidly into a serious life threatening environment which is hostile in the nth degree. Acidosis – pH below 7.4 is very unkind and unfriendly to human life.
The by-products of this deranged metabolism – which is by the way the bodies way of desperately trying to stay alive – are called ketones – these one can measure.
NOW, a 100 years ago we did not know about ketones, about 50 years ago we discovered a way to measure them in the URINE – major breakthrough. About 20!! years ago we learnt how to measure them in the BLOOD – this is FAR more accurate – far far more accurate, in terms of being related to the timing of what is actually happening in the body as well as giving an accurate quantitative measure of the ketones. In other words one can more accurately monitor and wash them out if you are checking the blood ketones.
Generally speaking if a doctor uses urine ketones to monitor and treat you it will take up to 10 days to get rid of the ketones. IF the doctor uses blood ketones you can see that they disappear (if of course you are doing the fluids correctly and the insulin infusion) within 12-24 hours at the most 48. Not you tell me, patient, medical aid and family which would YOU prefer? Ahospital stay of 2 days or 10 days, one in ICU or one in a well run ward?
Is there a good reason to use urine ketones over blood ketones? No I really don’t think so, it is like using a horse drawn cart to drive to work.
Sorry but I just can not take it any more. Surely it is indelibly printed on your inside if you are a doctor that you wish to do NO harm and wish to HELP your patient to the best of your ability? The best of our ability at this point in time when it comes to DKA is using blood ketones (not urine ketones and yes the occasional blood gas does help but it is a painful investigation and one can very easily and safely manage with new techology).