(Diabetic Coma; DKA)
by Alexandra Howson, PhD
Diabetic ketoacidosis (DKA) occurs when a person’s blood glucose is too high because there is not enough insulin. Instead, the body starts to burn fat for energy. Fat is broken down into acids, causing acid levels to build up in the blood. These acids appear in urine and blood as ketones. DKA is a serious condition that can lead to coma or death if it is not promptly treated.
Factors that may increase your risk of DKA:
DKA may cause:
Symptoms that require emergency care include:
You will be asked about your symptoms and medical history. A physical exam will be done. Blood and urine tests will be done.
An electrocardiogram (EKG) may also be done to check your heart's electrical activity.
DKA is treated with insulin, fluids, and minerals. This may require treatment in an intensive care unit.
Fluids and electrolytes will be given through IV to help your blood restore balance.
Insulin may be given by IV or injections. The insulin will immediately start reversing the cycle causing DKA. The insulin will let the body use glucose for fuel again. Fat will not be needed for fuel, so new ketones will not be made. The body will then be able to get rid of the extra ketones.
Close monitoring, exams, and blood tests will be needed during treatment
You may need additional treatment, such as antibiotics, if a bacterial infection is suspected.
You and your doctor will make a plan to manage your diabetes. These steps will also reduce the chance of DKA. Steps may include:
If your blood glucose is high and you have moderate amounts of ketones in your urine:
American Diabetes Association
National Institute of Diabetes and Digestive and Kidney Diseases
Canadian Diabetes Association
Public Health Agency of Canada
Diabetic ketoacidosis (DKA) in adults. EBSCO DynaMed Plus website. Available at: http://www.dynamed... . Updated August 23, 2017. Accessed August 25, 2017.
Diabetic ketoacidosis. Family Doctor website. Available at: https://familydoctor.org/condition/diabetic-ketoacidosis/. Updated June 2017. Accessed August 25, 2017.
Westerberg D. Diabetic ketoacidosis: Evaluation and treatment. Am Fam Physician. 2013;87(5):337-346.
Wolfsdorf J, et al. ISPAD Clinical Practice Consensus Guidelines 2014. Diabetic ketoacidosis and hyperglycemic hyperosmolar state. Pediatr Diabetes. 2014 Sep;15 Suppl 20:154-79.
Last reviewed September 2018 by EBSCO Medical Review Board Michael Woods, MD, FAAP
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