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Uncovering the basis of a severe degree of acidemia in a patient with diabetic ketoacidosis by M. Gowrishankar, A.P.C.P. Carlotti, C. St George-Hyslop,

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Presentation on theme: "Uncovering the basis of a severe degree of acidemia in a patient with diabetic ketoacidosis by M. Gowrishankar, A.P.C.P. Carlotti, C. St George-Hyslop,"— Presentation transcript:

1 Uncovering the basis of a severe degree of acidemia in a patient with diabetic ketoacidosis by M. Gowrishankar, A.P.C.P. Carlotti, C. St George-Hyslop, D. Bohn, K.S. Kamel, M.R. Davids, and M.L. Halperin QJM Volume 100(11):721-735 October 30, 2007 © The Author 2007. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

2 Overview of the biochemistry and physiology of ketoacidosis. M. Gowrishankar et al. QJM 2007;100:721-735 © The Author 2007. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

3 Uncoupling of oxidative phosphorylation and hepatic ketogenesis. M. Gowrishankar et al. QJM 2007;100:721-735 © The Author 2007. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

4 Balance for H+ and β-HB− when ketoacids are accumulating. M. Gowrishankar et al. QJM 2007;100:721-735 © The Author 2007. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

5 Indirect loss of NaHCO3. M. Gowrishankar et al. QJM 2007;100:721-735 © The Author 2007. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

6 Buffering of H+ in the brain in a patient with a contracted ‘effective’ arterial blood volume. M. Gowrishankar et al. QJM 2007;100:721-735 © The Author 2007. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

7 Time course for the rise in the PHCO3 in this patient. M. Gowrishankar et al. QJM 2007;100:721-735 © The Author 2007. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

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