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Diabetic ketoacidosis

DKA; Ketoacidosis; Diabetes - ketoacidosis

 

Diabetic ketoacidosis is a life-threatening problem that affects 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 is broken down to fuel the body, chemicals 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 (DKA) is sometimes the first sign of type 1 diabetes in people who have not yet been diagnosed. 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 DKA in people with type 1 diabetes.

People with type 2 diabetes can also develop DKA, but it is less common. It is usually triggered by uncontrolled blood sugar, missing doses of medicines, 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 DKA is suspected:

  • Most often, urine testing is done first.
  • If the urine is positive for ketones, most often beta-hydroxybutyrate is measured in the blood. This is the most common ketone measured.

Other tests for ketoacidosis include:

  • Arterial blood gas
  • Basic metabolic panel, (a group of blood tests that measure your sodium and potassium levels, kidney function, and other chemicals and functions)
  • Blood glucose test
  • Blood pressure measurement

 

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 provider right away. DO NOT delay. Follow any instructions you are given.

It is likely that 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)

 

Most people respond to treatment within 24 hours. Sometimes, it takes longer to recover.

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

 

Possible Complications

 

Health problems that may result from DKA include any of the following:

  • Fluid buildup in the brain (cerebral edema)
  • Heart stops working (cardiac arrest)
  • Kidney failure

 

When to Contact a Medical Professional

 

DKA is often a medical emergency. Call your provider if you notice symptoms of DKA.

Go to the emergency room or call the local emergency number (such as 911) if you or a family member with diabetes has any of the following:

  • Decreased consciousness
  • Fruity breath
  • Nausea and vomiting
  • Trouble breathing

 

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

Pasquel FJ, Umpierrez GE. Hyperglycemic crises. In: Jameson JL, De Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric. 7th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 46.

Standards of Medical Care in Diabetes-2016: Summary of Revisions. Diabetes Care. 2016:39;Suppl 1:S4-S5. PMID: 26696680 www.ncbi.nlm.nih.gov/pubmed/26696680.

Westerberg DP. Diabetic ketoacidosis: evaluation and treatment. Am Fam Physician. 2013;87(5):337-46. PMID: 23547550 www.ncbi.nlm.nih.gov/pubmed/23547550.

 
  • Food and insulin release

    Food and insulin release - illustration

    Insulin is a hormone secreted by the pancreas in response to increased glucose levels in the blood.

    Food and insulin release

    illustration

  • Oral glucose tolerance test

    Oral glucose tolerance test - illustration

    During the oral glucose tolerance test your blood glucose is tested two hours after drinking 75 grams of glucose. You are diagnosed with diabetes if your blood glucose level is 200 mg/dl or greater.

    Oral glucose tolerance test

    illustration

  • Insulin pump

    Insulin pump - illustration

    Various styles of insulin pumps may be utilized by people with diabetes to inject insulin into the body in a controlled, more convenient and discreet manner.

    Insulin pump

    illustration

    • Food and insulin release

      Food and insulin release - illustration

      Insulin is a hormone secreted by the pancreas in response to increased glucose levels in the blood.

      Food and insulin release

      illustration

    • Oral glucose tolerance test

      Oral glucose tolerance test - illustration

      During the oral glucose tolerance test your blood glucose is tested two hours after drinking 75 grams of glucose. You are diagnosed with diabetes if your blood glucose level is 200 mg/dl or greater.

      Oral glucose tolerance test

      illustration

    • Insulin pump

      Insulin pump - illustration

      Various styles of insulin pumps may be utilized by people with diabetes to inject insulin into the body in a controlled, more convenient and discreet manner.

      Insulin pump

      illustration

    A Closer Look

     

      Self Care

       

        Tests for Diabetic ketoacidosis

         

           

          Review Date: 7/24/2015

          Reviewed By: Brent Wisse, MD, Associate Professor of Medicine, Division of Metabolism, Endocrinology & Nutrition, University of Washington School of Medicine, Seattle, WA. Internal review and update on 09/01/2016 by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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