What Is Diabetic Ketoacidosis (DKA)?

~ by Jo Jordan

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Diabetic Ketoacidosis (DKA) is a dangerous, potentially life-threatening complication of diabetes that many people are unaware of. Also known as diabetic acidosis, DKA is a condition in which the chemical balance of the body (pH) becomes exceedingly acidic, leaving the body vulnerable to a diabetic coma and death.

The body must maintain a pH balance of 7 to 7.25. Any reading lower than 7 is too acidic. DKA develops when dangerously high numbers of ketones (poisonous acidic chemicals produced by the liver in response to insulin deficiency) accumulate in the body’s tissues and fluids, resulting in a loss of water, potassium, ammonium, and sodium.

When there isn’t enough insulin present to transport glucose to the body’s cells, fat – instead of glucose – is burned to make energy. Ketones are produced during this process, resulting in an abnormal decrease in blood plasma volume, electrolyte imbalance, extremely high blood glucose levels, and the breakdown of free fatty acids.

There are three major components to DKA: hyperketonemia (an overproduction of ketones); hyperglycemia (excessively high blood sugar kevels); and acidosis (the blood has become too acidic).

Diabetic Ketoacidosis Warning Signs and Symptoms

While DKA normally develops slowly, once vomiting begins onset of this dangerous condition can happen rapidly...within just a few hours:

Abdominal pain
Blurred or unclear vision
Coma
Confusion
Dehydration
Difficulty breathing; rapid, deep breathing; shortness of breath
Dry mouth
Excessive thirst
Fatigue and lethargy
Flushing
Frequent urination
Fruity odor to breath
High blood sugar levels
High keytone levels
Hot, dry skin
Loss of appetite
Muscle stiffness or aching
Nausea
Perspiration
Restlessness, discomfort, agitation
Unconsciousness
Vomiting
Weakness

DKA can be fatal. If you have any of the above symptoms, contact your health care provider immediately, or go to the nearest emergency room hospital.

Triggers and/or Causes of Diabetic Ketoacidosis

Alcohol or drug consumption
An illness or infection (including colds and flus)
An insulin reaction (low blood glucose)
Failure to take insulin
Gastrointestinal (GI) upset
Heart attack
High fever
Not getting enough insulin
Not getting enough food
Physical or emotional trauma
Stress
Stroke
Surgery
Undiagnosed type 1 diabetes

Who Gets Diabetic Ketoacidosis?

The risk of developing DKA is greatest for those under nineteen years of age who have type I diabetes. In childhood, onset of type I diabetes is usually sudden, with quick progression. As a result, diagnosis of type I diabetes is often made when a child arrives at the hospital with DKA. In other instances, DKA is brought on by the interruption of insulin treatment, acute infection, or trauma.

While DKA is most common in those with type I diabetes, it can happen to anyone, even those with type 2 or gestational diabetes. Sometimes DKA can be the first sign that a person has diabetes. Older people with type 2 diabetes – especially those who are non-insulin dependent – may experience hyperosmolar nonketotic coma, rather than DKA.

Diagnosing Diabetic Ketoacidosis

DKA is a serious condition that – if left untreated – can lead to illness and death, so it is important to monitor your body for ketones if you have any type of diabetes and are sick, stressed, and/ or pregnant, or your blood glucose level goes above 240 mg/dl (a measure of concentration using milligrams per decilitre).

Your body will try to eliminate excess ketones, so they can be detected and measured in your urine. Commercially available test strips can be submerged into urine to determine the presence and concentration level of ketones.

Ketone test kits come with instructions for using the test strips, but it’s also important to ask your health care provider to show you how to keep a record of your blood glucose readings. This will help guide you in knowing how often to test for ketones.

A blood test can also determine the concentration of glucose in your bloodstream.

Diabetic Ketoacidosis Prevention and Treatment

Administer and adjust insulin dosage (taking blood sugar levels, nutrition, overall health, stress, and physical activity level into account);
Be prepared to act quickly – call your health care provider if you have DKA symptoms, or if your blood sugar and/or ketone levels become too high;
Commit to a healthy lifestyle of daily activity and nutritious eating; consider a multi-vitamin to ensure adequate vitamin, mineral, and nutrient intake, and to promote overall health;
Do not exercise when ketone and/or blood glucose levels are high;
Perform careful, regular monitoring of blood sugar levels, especially if you’re ill (check every four to six hours when it is higher than 240 mg/dl); and
Undergo regular ketone testing, if warranted (check every four to six hours when you are ill).

Treatment

Administering insulin to reduce high glucose levels and ketone levels;
Balancing electrolytes to re-establish the blood’s chemical equilibrium and prevent potassium deficiency;
Intravenously replacing the fluids lost through excessive urination and vomiting; and
Treating any associated bacterial infection.

Diabetic Ketoacidosis Complications and Prognosis

Complications¹

The most common complications of diabetic ketoacidosis are related to insulin treatment:

Low blood sugar (hypoglycemia): Insulin allows sugar to enter your cells. This causes your blood sugar level to drop. If your blood sugar level drops too quickly, you may develop low blood sugar.
Low potassium (hypokalemia): The fluids used to treat diabetic ketoacidosis may cause your potassium level to drop too low.
Swelling in the brain (cerebral edema): Adjusting your blood sugar level too quickly can produce brain swelling. This complication tends to be more common in children, especially those who have newly diagnosed diabetes.

Prognosis

For those with childhood diabetes, complications from DKA represent the leading cause of death, mostly due to accumulations of abnormally large amounts of fluid in the brain (cerebral edema).

Major causes of death from DKA are circulatory collapse, hypokalemia, infection, and cerebral edema.

With proper medical attention, however, DKA is treated successfully in the majority of cases.²

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Notes:
1. Mayo Foundation for Medical Education and Research (MFMER), “Diabetic ketoacidosis,” http://www.mayoclinic.com/health/diabetic-ketoacidosis/DS00674 (accessed March 23, 2009).
2. Islets of Hope: complications of diabetes, “Diabetic ketoacidosis,” http://www.isletsofhope.com/diabetes/complications/diabetic_ketoacidosis_dka_1.html (accessed March 23, 2009).