Diabetic Ketoacidosis

Overview

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 promptly treated.

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 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 your risk of DKA are:

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

SymptomsandDiagnosis

Symptoms

DKA may cause:

  • 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
  • Rapid or difficult breathing
  • Drowsiness
  • Vomiting and nausea
  • Fruity breath odor
  • Rapid 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.

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

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

Treatments

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, new ketones will not be made. The body will then be able to get rid of the extra ketones.

IV Being Placed in Hand
IV insertion
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Prevention

You and your doctor will make a plan to manage your diabetes. These steps will also reduce the chance of DKA. Steps may include:

  • Take your insulin as recommended. Always have insulin available. Plan ahead for refills.
  • Check blood glucose levels as recommended. It should be at least 3 to 4 times per day. Check more often when you are sick or have had high blood glucose levels.
  • Drink plenty of fluids throughout the day.
  • Check for ketones in your urine if you have a high blood glucose reading or are ill.
  • Create a sick day plan. It may include changes in insulin dose and what to do if you are having trouble eating.

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

Edits to original content made by Denver Health.

a (Diabetic Coma; DKA)

RESOURCES

American Diabetes Association http://www.diabetes.org 

National Institute of Diabetes and Digestive and Kidney Diseases http://www.niddk.nih.gov 

CANADIAN RESOURCES

Canadian Diabetes Association http://www.diabetes.ca 

Public Health Agency of Canada http://www.phac-aspc.gc.ca 

References

Diabetic ketoacidosis (DKA) in adults. EBSCO DynaMed website. Available at:  https://www.dynamed.com/condition/diabetic-ketoacidosis-dka-in-adults  . Updated August 23, 2017. Accessed March 13, 2020.

Diabetic ketoacidosis. Family Doctor website. Available at: https://familydoctor.org/condition/diabetic-ketoacidosis/. Updated June 2017. Accessed March 13, 2020.

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.