Diabetic Ketoacidosis

Definition

Diabetic ketoacidosis (DKA) is a high level of ketones in the body. DKA is a serious condition that can lead to coma or death if it is not treated right away.

Causes

Glucose is the main source of fuel for the body. Diabetes makes it hard for the body to use glucose. The body starts to breakdown fat for energy instead. Ketones are chemicals that are released with the breakdown of fat. The more fat is used, the higher ketone levels will be.

DKA is most often caused by uncontrolled type 1 diabetes. Type 2 diabetes can also lead to DKA but it is less common cause.

Risk Factors

Things that may increase the risk of DKA are:

• Not taking insulin as prescribed—or not taking insulin at all
• Type 1 diabetes that has not been diagnosed
• Health conditions such as:
  • Stomach illness with a lot of vomiting
  • Infections such as pneumonia , urinary tract infection , or sepsis
  • Heart disease, such as heart attack
  • Recent stroke
  • Blood clot to the lungs
• Pregnancy
• Surgery
• Some medicine, such as steroids or antipsychotic drugs
• Illegal drugs, such as cocaine
• Serious trauma

Symptoms

Symptoms of DKA may include:

• High blood glucose levels (greater than 250 mg per dL)
• Dry mouth and skin
• Thirst
• Peeing often

Symptoms that show emergency care is needed include:

• Severe stomach pain
• Fast or difficult breathing
• Drowsiness
• Vomiting and nausea
• Fruity breath odor
• Fast pulse
• Headache

Diagnosis

The doctor will ask about symptoms and past health. A physical exam will be done. Blood and urine tests will be done to diagnose DKA.

• Blood and urine will be checked for ketones.
• The levels of glucose and other substances in the blood will be tested.
• An arterial blood sample will be taken—to test the amount of acid in the blood. This will determine how severe DKA is.
• Tests for infection may also be done.

An electrocardiogram (EKG) may also be done. It will show any problems with the heart's electrical activity.

Treatment

DKA is treated with insulin, fluids, and minerals. Care may need to take place in a hospital. Close monitoring, exams, and blood tests will be needed.

Insulin may be given by IV or injections. 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.

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Prevention

To help prevent of DKA:

• Take insulin as advised. Always have insulin available. Plan ahead for refills.
• Check blood glucose levels as advised. It should be at least 3 to 4 times per day. Check more often during illness or if blood glucose levels have been high.
• Drink plenty of fluids throughout the day.
• Check for ketones in urine after a high blood glucose reading or during an illness.
• Create a sick day plan. It may include changes in insulin dose and what to do if you have problems eating.