Diabetic Ketoacidosis (DKA): Symptoms and Treatment

Diabetic ketoacidosis (DKA) usually occurs in people who are suffering from type I diabetes (insulin-dependent). DKA occurs when the body is affected by hyperglycemia, a condition when the body has little or no insulin to use and the blood glucose levels keep rising to severe levels. From hyperglycemia, it progresses to ketosis, an abnormal increase of ketone bodies in the blood. Ketosis further leads to acidosis in which the blood becomes acidic. This condition is known as diabetic ketoacidosis. In this condition, the body starts consuming muscle, fat and liver cells for fuel in place of glucose (sugar). Hence, the body shifts from its normal metabolism of using carbohydrates as fuel to a state of using fat as fuel. This causes increased urination and dehydration due to which nearly 10% of total body fluids may be lost. Along with this, significant loss of potassium from urination is also common. Infection, missing insulin and newly diagnosed diabetes in a patient are some prominent causes of diabetic ketoacidosis. Other causes may include heart attacks, strokes, stress, trauma and surgery.

Symptoms for Diabetic Ketoacidosis

The signs and symptoms for diabetic ketoacidosis begin slowly and sometimes can be mistaken for other illnesses.

• Feeling tired or fatigued
• Excessive thirst and excessive urination
• Nausea and vomiting
• Abdominal pain
• Signs of dehydration such as dry mouth and dry skin
• Rapid, deep, labored breathing (Kussmaul's respirations)
• Fever and unconsciousness
• Loss of appetite or eating disorder
• General weakness and confusion
• Increased heart rate and low blood pressure
• Sometimes a distinctive fruity odor in the breath
• Acute pancreatitis, appendicitis or gastrointestinal perforation

Small children suffering with DKA are more prone to cerebral edema (swelling of the brain tissue), that causes headaches, coma, loss of the pupillary light reflex and further leads to death. However, it is more common in adults.

Diagnose and Treatment for Diabetic Ketoacidosis

DKA is typically diagnosed by a blood test which checks the levels of blood sugar, potassium, sodium, other electrolytes and blood acid concentration (pH). Other tests for DKA include chest X-ray, ECG, urine analysis, and if required, a CT scan of the brain.

The treatment for DKA starts from home, especially for people who are suffering from type I diabetes. The patient should regularly monitor the blood sugar level at least 3-4 times a day. If there are moderate elevations in blood sugar, it can be treated with additional injections of a short-acting form of insulin. The most principal and critical treatment for DKA is intravenous fluid replacement, which is given through a vein. Potassium is usually added to IV fluids to compensate for the loss. It reverses the dehydration and dilutes glucose and acid levels. Insulin should be given to reduce the blood sugar and prevent further ketone formation. Once the blood sugar levels have fallen to 250 mg, extra glucose should be provided to allow continued insulin administration without hypoglycemia.

People diagnosed with DKA are usually admitted into the hospital for immediate treatment and may be shifted to the intensive care unit, if the condition exasperates. In mild cases, the patient may be treated and released from the emergency department considering that the patient will regularly follow up with the doctor.

The key to prevent diabetic ketoacidosis includes close monitoring and control of blood sugars, especially during infections, stress, trauma, or other serious illnesses. By taking insulin injections on time and contacting the physician when needed, the patient can also live a normal and healthy life.