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

Alternative Names

DKA; Ketoacidosis

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 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 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, missing doses of medications, 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:

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

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.

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)

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

Possible Complications

When to Contact a Medical Professional

DKA is often a 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 you or a family member with diabetes has any of the following:

  • 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 -- 2014. Diabetes Care. 2014;37:S14-S80.

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: Saunders Elsevier; 2011:chap 32.

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

Updated: 8/5/2014

Brent Wisse, MD, Associate Professor of Medicine, Division of Metabolism, Endocrinology & Nutrition, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.


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