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    Diabetic Ketoacidosis

    DKA; Ketoacidosis

    Diabetic ketoacidosis is a life-threatening problem thataffects people with diabetes. It occurs when the body cannot use sugar (glucose) as a fuel source because there is no insulin or not enough insulin. Fat is used for fuel instead.

    When fat breaks down, waste products called ketones build up in the body.

    Causes

    As fat is broken down, acids called ketones build up in the blood and urine. In high levels, ketones are poisonous. This condition is known as ketoacidosis.

    Diabetic ketoacidosis is often the first sign of type 1 diabetes in people who do not yet have other symptoms. It can also occur in someone who has already been diagnosed with type 1 diabetes. Infection, injury, a serious illness, missing doses of insulin shots, or surgery can lead to diabetic ketoacidosis in people with type 1 diabetes.

    People with type 2 diabetes can also develop ketoacidosis, but it is less common. It is usually triggered by uncontrolled blood sugar or a severe illness.

    Symptoms

    Common symptoms can include:

    • Decreased alertness
    • Deep, rapid breathing
    • Dry skin and mouth
    • Flushed face
    • Frequent urination or thirst that lasts for a day or more
    • Fruity-smelling breath
    • Headache
    • Muscle stiffness or aches
    • Nausea and vomiting
    • Stomach pain

    Exams and Tests

    Ketone testing may be used in type 1 diabetes to screen for early ketoacidosis. The ketones test is usually done using a urine sample or a blood sample.

    Ketone testing is usually done:

    • When the blood sugar is higher than 240 mg/dL
    • During an illness such as pneumonia, heart attack, or stroke
    • When nausea or vomiting occur
    • During pregnancy

    Other tests for ketoacidosis include:

    • Amylase blood test
    • Arterial blood gas
    • Blood glucose test
    • Blood pressure measurement
    • Potassium blood test

    This disease may also affect the results of the following tests:

    • CO2
    • Magnesium blood test
    • Phosphorus blood test
    • Sodium blood test
    • Urine pH

    Treatment

    The goal of treatment is to correct the high blood sugar level with insulin. Another goal is to replace fluids lost through urination, loss of appetite,and vomiting if you have these symptoms.

    If you have diabetes, it is likely your health care provider told you how to spot the warning signs of DKA. If you think you have DKA, test for ketones using urine strips or your glucose meter. If ketones are present, call your health care provider right away. Do not delay. Follow any instructions you are given.

    Most of the time, you will need to go to the hospital. There, you will receive insulin, fluids and other treatment for DKA. Then doctors will find and treat the cause of DKA, such as an infection.

    Outlook (Prognosis)

    If DKAis not treated, it can lead to severe illness or death.

    • Fluid buildup in the brain (cerebral edema)
    • Heart attack and death of bowel tissue due to low blood pressure
    • Kidney failure

    When to Contact a Medical Professional

    DKAis oftena medical emergency. Call your health care provider if you notice symptoms of DKA.

    Go to the emergency room or call the local emergency number (such as 911) if youor a family member with diabetes have:

    • Decreased consciousness
    • Fruity breath
    • Nausea
    • Trouble breathing
    • Vomiting

    Prevention

    If you have diabetes, learn to recognize the signs and symptoms of DKA. Know when to test for ketones, such as when you are sick.

    If you use an insulin pump, check often to see that insulin is flowing through the tubing. Make sure the tube is not blocked, kinked or disconnected from the pump.

    References

    American Diabetes Association. Standards of medical care in diabetes -- 2013. Diabetes Care. 2013;36 Suppl 1:S11-S66.

    Eisenbarth GS, Buse JB. Type 1 diabetes mellitus. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM. Williams Textbook of Endocrinology. 12th ed. Philadelphia, Pa.: Elsevier Saunders; 2011: chap 32.

    Westerberg DP. Diabetic ketoacidosis: evaluation and treatment. Am Fam Physician. 2013;87:337-346

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            Review Date: 6/7/2013

            Reviewed By: Brent Wisse, MD, Associate Professor of Medicine, Division of Metabolism, Endocrinology & Nutrition, University of Washington School of Medicine. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Black, Stephanie Slon, and Nissi Wang.

            The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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