Diabetic Ketoacidosis

Overview, Causes, & Risk Factors

Diabetic ketoacidosis, or DKA, is a condition in which the body has a severedeficiency of insulin. Insulin is a hormone that helps regulate the level ofglucose in the blood. Glucose is the main form of sugar in the body. DKA is aserious complication of diabetes.

What is going on in the body?

Diabetes ketoacidosis is a serious but treatable complication of diabetes. Aperson who has DKA has a significant deficiency of insulin in his or her body.Without insulin, the body is unable to move glucose from the bloodstream to thebody cells.This results in high levels of glucose and acids in the blood. DKA occursmainly in those who have type 1diabetes. Rarely, it can occur in those who havetype 2 diabetes.

What are the causes and risks of the condition?

DKA often occurs in children and young adults before they arediagnosed with type 1diabetes. The symptoms of DKA often cause people to see ahealthcare provider even before they are diagnosed with diabetes. DKA canalso occur if a person with diabetes fails to take the right amount of insulinat the right time. It is seen more often in people younger than the age of 19,but can occur in anyone who has diabetes.

Forty percent of the time, DKA is caused by an infection. Urinary tractinfections are the most common of these. Following are some other causes ofDKA:

  • complications of pregnancy
  • heart attack
  • injury
  • stress
  • stroke
  • surgery
  • trauma, or severe injury
  • Symptoms & Signs

    What are the signs and symptoms of the condition?

    Early signs of DKA include the classic signs of high bloodglucose:

  • excessive hunger
  • excessive thirst
  • increased urination
  • As the person’s blood glucose level continues to rise, more symptomsmay occur, such as:

  • abdominal pain
  • confusion
  • dehydration, withdecreased sweating
  • fatigue
  • fruity odor of the breath
  • loss of appetite
  • malaise, or avague feeling of illness
  • nausea andvomiting
  • weakness
  • If the DKA progresses, the person may fall into a coma.

    People may also have symptoms of an underlying infection, such as thefollowing:

  • abdominal pain
  • chest pain
  • chills
  • fever
  • painful urination
  • shortness of breath
  • Diagnosis & Tests

    How is the condition diagnosed?

    The diagnosis of diabetic ketoacidosis begins with a medical history andphysical exam.Blood glucose tests canmonitor the effect of insulin on the body. The provider may order blood andurine tests to detect underlyinginfection or illness.

    Prevention & Expectations

    What can be done to prevent the condition?

    Knowledge of the early signs and symptoms of new-onset or poorly controlleddiabetes can help prevent some cases. These signs and symptoms may include thefollowing:

  • excessive hunger
  • excessive thirst
  • fatigue
  • general decline in health
  • increased urination
  • weight loss
  • People who have diabetes should take their insulin as directed. If a person isunable to eat, the healthcare provider should be contacted. He or she can giveadvice about insulin dosages.

    People with diabetes are advised to check their blood glucose level regularly, as instructed by thehealthcare provider. If the blood glucose level is high several times in a row,a person shouldcontact the provider. It is important to seek early treatment for infectionsand other illnesses. Blood glucose levels need to be checked even morecarefully when the person is not well.

    What are the long-term effects of the condition?

    DKA is generally a reversible problem, resulting in death only 2% of the time.Children with DKA are at high risk for death from cerebral edema, or brainswelling. In fact, DKA causes 70% of diabetes-related deaths in childrenyounger than10 years of age. Damage to the brain and other organs is a rare complication ofDKA. However, most people recover without any long-term effects.

    What are the risks to others?

    DKA is not contagious and poses no risks to others.

    Treatment & Monitoring

    What are the treatments for the condition?

    Treatment is directed at the DKA and any underlying conditions. For example,antibiotics or surgery may be needed for aninfection. Fluids and insulin are generally given through an intravenous line, or IV. An IV is athin tube that is placed into a person’s vein, usually in the arm. Saltreplacement is also commonly needed and is supplied through the IV. Peopleoften need care inan intensive care unitwith frequent monitoring. Treatment may last several hours or several days.

    What are the side effects of the treatments?

    Getting too much fluid or the wrong kind of fluid can cause swelling of thebrain, known as cerebral edema. A low blood glucose level is rarely a problem,but mayoccur if too much insulin is given. Antibiotics may cause allergic reactions, stomach upset,andother side effects.

    What happens after treatment for the condition?

    People who have diabetes need lifelong treatment. After an episode of DKA, theindividual may need further instruction about diabetes. Educationincludes information on diet, exercise, insulin dosage, and blood glucose monitoring. A person’s insulin dose mayneed tobe changed in some cases.

    How is the condition monitored?

    The individual may have frequent visits with the healthcareprovider until the diabetes is well controlled. Any new or worsening symptomsshould be reported to the provider.

    Article type: xmedgeneral