Acid-base disturbances mini-lecture (2/3): diabetes melitus type 1 and Kussmaul breathing
Channel: Remco Jongkind & Dave Speijer - Medical Education
Date: 2020-02-28

This video will cover:
1. How diabetes melitus type 1 can cause a metabolic acidosis due to an excess of ketone bodies.
2. How the body tries to compensate this acidosis with Kussmaul breathing. 
3. How to treat this metabolic acidosis. 

Bullet point summary: 
-Diabetes melitus type 1 is caused by an insulin deficiency and glucagon excess. This leads to reduced glucose uptake by the cells and increased glycogen breakdown by the liver. 
-This insulin deficiency and glucagon excess also leads to increased release of free fatty acids (FFA) and the synthesis of ketone bodies from these FFA. 
-These ketone bodies cause the blood pH to drop, leading to a metabolic acidosis. 
-The body tries to bring back the blood pH to normal levels by breathing deeper and exhaling more carbondioxide (Kussmaul breathing). 
-If Kussmaul breathing is not sufficient to compensate the pH shift the patient may end up in a coma or even die. 
-Treatment consists of fluid and electrolyte replacement and insulin administration. 

Bullet point summary previous mini-lecture: 
-Physiological pH is 7.4. 
-When your pH is higher than 7.4 you have a metabolic alkalosis or respiratory alkalosis. 
-When your pH is lower than 7.4 you have a metabolic acidosis or respiratory acidosis.
-Blood pH is mainly buffered by the phosphate, hemoglobin and carbonate buffers. 
-Phosphate and hemoglobin are closed buffer systems. The constituents of the buffers are not exchanged with the environment. 
-The carbonate-bicarbonate buffer is an open buffer system. The constituents of the buffer are exchanged with the environment. This is done by the kidneys and by the lungs. 
-Davenport diagram is an often used tool to evaluate acid-base disturbances. 
-Hyperventilation causes a drop in carbondioxide levels in the blood, leading to a rise in pH. 
-COPD causes a rise in carbondioxide levels, leading to a drop in pH.