Diabetic ketoacidosis (blood sugar)

Head | Emergency Medicine | Diabetic ketoacidosis (blood sugar) (Disease)


Diabetic ketoacidosis (DKA) is a potentially life-threatening complication in patients with diabetes mellitus. It happens predominantly in those with type 1 diabetes, but it can occur in those with type 2 diabetes under certain circumstances.

Diabetic ketoacidosis can lead to rapid breathing, flushing, fruity-smelling breath, nausea, vomiting, pain, fatigue, headache, and muscle stiffness. In severe cases, ketoacidosis can lead to a slowing of mental activity that can progress to a coma. The consequences of ketoacidosis can be severe, even life threatening, but modern treatments are usually very effective at preventing serious complications if treatment is obtained early.

The symptoms of an episode of diabetic ketoacidosis usually evolve over the period of about 24 hours. Predominant symptoms are nausea and vomiting, pronounced thirst, excessive urine production and abdominal pain that may be severe. Those who measure their glucose levels themselves may notice hyperglycemia (high blood sugar levels). The abdomen may be tender to the point that an acute abdomen may be suspected, such as acute pancreatitis, appendicitis or gastrointestinal perforation.

Causes and Risk factors

Diabetic ketoacidosis is triggered by insufficient insulin, which causes glucose to accumulate in the bloodstream. Without adequate insulin, the body cannot metabolize the glucose so it begins to breakdown fats for energy. This leads to high acid levels in the bloodstream, as well as severe dehydration. Diabetic ketoacidosis occurs in about 1 out of 2000 people with type 1 diabetes.

The most common causes of DKA are not taking the correct amounts of insulin and a secondary stress to the body such as infections, surgery and trauma.

Diagnosis and Treatment

Intravenous fluids and insulin are the mainstays of therapy. Correction of metabolic abnormalities such as low sodium or potassium is necessary as well. Treatment of the cause of the DKA must also be reversed.


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