Diabetic Ketoacidosis (DKA)

Topic Overview

What is diabetic ketoacidosis (DKA)?

Diabetic ketoacidosis (DKA) is a life-threatening condition that develops when cells in the body are unable to get the sugar (glucose) they need for energy, such as when you have diabetes and do not take enough insulin. Without insulin, the body cannot use sugar for energy. When the cells do not receive sugar, the body begins to break down fat and muscle for energy. When this happens, ketones, or fatty acids, are produced and enter the bloodstream, causing the chemical imbalance (metabolic acidosis) called diabetic ketoacidosis.

What causes DKA?

Ketoacidosis can be caused by not taking enough insulin, having a severe infection or other illness, becoming severely dehydrated, or some combination of these factors. It can occur in people who have little or no insulin in their bodies (mostly people with type 1 diabetes, but it can happen with type 2 diabetes) when their blood sugar levels are high.

What are the symptoms?

Your blood sugar may be quite high before you notice symptoms, which include:

  • Flushed, hot, dry skin.
  • Blurred vision.
  • Feeling thirsty.
  • Drowsiness or difficulty waking up. Young children may lack interest in their normal activities.
  • Rapid, deep breathing.
  • A strong, fruity breath odor.
  • Loss of appetite, abdominal pain, and vomiting.
  • Confusion.

When diabetic ketoacidosis is severe, you may have difficulty breathing, your brain may swell (cerebral edema), and there is a risk of coma and even death.

How is DKA diagnosed?

Laboratory tests, including blood and urine tests, are used to confirm a diagnosis of diabetic ketoacidosis. Urine dipstick tests for ketones are available for home use. Keep some nearby in case your blood sugar level becomes high.

How is it treated?

When ketoacidosis is severe, it must be treated in the hospital, often in an intensive care unit. Treatment involves giving insulin and fluids through a vein and closely monitoring certain chemicals in the blood (electrolytes). It can take several days for your blood sugar level and fluid status to return to a safe range.

Who is at risk for DKA?

If you have type 1 diabetes, you are at risk for DKA if you do not take enough insulin, have a severe infection or other illness, or become severely dehydrated. In some cases DKA can be the first sign of diabetes.

References

Other Works Consulted

  • Eisenbarth GS, et al. (2008). Type 1 diabetes mellitus. In PR Larsen et al., eds., Williams Textbook of Endocrinology, 11th ed., pp. 1391–1416. Philadelphia: Saunders Elsevier.
  • Genuth S (2008). Type 1 diabetes mellitus. In DC Dale, DD Federman, eds., ACP Medicine, section 9, chap. 1. New York: WebMD.
  • Masharani U, German MS (2007). Pancreatic hormones and diabetes mellitus. In DG Gardner et al., eds., Greenspan's Basic and Clinical Endocrinology, 8th ed., pp. 716–746. New York: McGraw-Hill.
  • Wyckoff J, Abrahamson MJ (2005). Diabetic ketoacidosis and hyperosmolar hyperglycemic state. In Joslin's Diabetes Mellitus, 14th ed., pp. 887–899. Philadelphia: Lippincott Williams and Wilkins.

Credits

Author Caroline Rea, RN, BS
Editor Susan Van Houten, RN, BSN
Associate Editor Pat Truman, MATC
Primary Medical Reviewer Caroline S. Rhoads, MD - Internal Medicine
Specialist Medical Reviewer Jennifer Hone, MD - Endocrinology, Diabetes and Metabolism
Last Updated June 12, 2008

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