Diabetic ketoacidosis

Alternative names

DKA; Ketoacidosis; Diabetic coma

Definition

Diabetic ketoacidosis is a complication of diabetes mellitus caused by the buildup of by-products of fat metabolism (ketones), which occurs when glucose is not available as a fuel source for the body.

Causes, incidence, and risk factors

People with diabetes lack sufficient insulin, a hormone the body uses to process glucose (a simple sugar) for energy. When glucose is not available, body fat is broken down instead. The by-products of fat metabolism are ketones. When fat is metabolized, ketones build up in the blood and "spill" over into the urine. A condition called ketoacidosis develops when the blood becomes more acidic than body tissues.

Blood glucose levels become elevated (usually higher than 300 mg/dL) because the liver produces glucose to try to combat the problem and because cells cannot take up that glucose without insulin. Diabetic ketoacidosis may lead to the initial diagnosis of type 1 diabetes, as it is often the first symptom that causes the person to come to medical attention. It can also be the result of increased insulin needs in someone already diagnosed with type 1 diabetes. Infection, trauma, heart attack, or surgery can lead to diabetic ketoacidosis in such cases.

People with type 2 diabetes usually develop ketoacidosis only under conditions of severe stress. Poor compliance with diet and treatment is usually the cause when episodes are recurrent.

Symptoms

• Frequent urination or frequent thirst for a day or more
  
• Fatigue
  
• Nausea and vomiting
  
• Muscular stiffness or aching
  
• Mental stupor that may progress to coma
  
• Rapid deep breathing
  
• Fruity breath (breath odor)
  

Additional symptoms that may be associated with this disease:

• Headache
  
• Decreased consciousness
  
• Breathing - rapid
  
• Breathing difficulty - lying down
  
• Low blood pressure
  
• Appetite - loss
  
• Abdominal pain
  

Signs and tests

• Low blood pressure
  
• Rapid heart rate