A person is brought to the emergency room in what appears to be a drunken stupor. On closer examination, she seems to be breathing very rapidly and you notice a sweet-smelling odor on her breath. You find out this person has not been drinking alcohol. What is her likely condition?

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Hello, everyone. And welcome back. Our next question is a person is found unresponsive in a library. Friends report that she has been extremely stressed and not eating well for days. They also confirm that she has not been drinking alcohol. She has a history of type one diabetes and her breath is a fruity odor. On closer examination has been found out by the emergency personnel that she is in DK A. What is the likely cause of the fruity odor? Well, without looking, we don't even need all the history here because we're told that the diagnosis is AD K A. So if we remember that that stands for diabetic ketoacidosis, then you know, we know the diagnosis and that literally means that ketone body levels are high in the blood and one of these ketones will be so put including acetone, which can have a fruity odor. So the likely cause of the fruity odor is acetone. So we'll put highlight that as our answer to go a little further. Why is it that you know DK A as a result? Why would, why would this become the diagnosis here? Not been drinking alcohol is important because there is alcoholic ketoacidosis. So it's important to know that it's diabetic ketoacidosis, so it can be treated properly. So, knowing she has type one diabetes, she's not been eating well. She's been stressed. Stress can make DK a more likely as the stress hormones interfere with the action of insulin and cause higher blood glucose levels. So cause glucose to be, you know, released from the cells out into the bloodstream. So it's ready to be used. But of course, the problem with diabetes is that it means you're already not producing enough insulin. You have too much glucose in the blood and your body can't officially take it up into the cells to use for energy. So in addition, she's not eating well, perhaps her carb intake is low, which again, that can contribute. Although usually you'd want to eat lower carb as a person with diabetes. But the main issue being this low insulin means the cells don't have enough glucose. So it may be circulating around the blood, but cells don't have enough glucose for their energy needs. So the body turns to its alternative methods, Gluco genesis. So it's trying to manufacture glucose by its own pathway and break down of fatty acids or break down of fats, I should say. And of course, the breakdown of fats, you break the fat into glycerol and fatty acids and you have beta oxidation of the fatty acid components and that produces a cy ka well, acetyl coa can be fed into the citric acid cycle, but we've got gluconeogenesis going on which uses oxalacetate. So there's not as much of that available to for the citric acid cycle and for acetyl coa to combine with. So that's going to sort of prevent, put a little swig there, acetyl coa from going to the citric acid cycle, rather acetyl coa will produce ketone bodies. And as we said, one of those will be acetone causing a fruity odor on the breath. So again, for a patient that's in diabetic keto ketoacidosis or DK A, the likely cause of the fruity odor on her breath will be the presence of acetone in her blood. See you in the next video.

A person is brought to the emergency room in what appears to be a drunken stupor. On closer examination, she seems to be breathing very rapidly and you notice a sweet-smelling odor on her breath. You find out this person has not been drinking alcohol. What is her likely condition?

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Key Concepts

Diabetic Ketoacidosis (DKA)

Acidosis

Differential Diagnosis