DKA usually occurs in people who are suffering from type I diabetes (insulin-dependent). In this, the body is affected by hyperglycemia, a condition in which the blood glucose level becomes abnormally high, because the body is unable to use this glucose due to lack of insulin. Instead, the body starts breaking down fat as an alternative source of fuel in place of glucose (sugar). This results in a build-up of a by-product called ketones, and the condition is called ketosis.
It further leads to acidosis in which the blood becomes acidic due to the aggregation of ketones and organic acids. This condition is known as DKA. 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 the total body fluids may be lost. Along with this, significant loss of potassium through urination is also common. Infection, missing insulin, and newly-diagnosed diabetes in a patient are some of the prominent causes of ketoacidosis. Other causes may include heart attack, stroke, stress, trauma, and surgery.
The initial DKA symptoms develop slowly when the body detects that ketones are being produced. Sometimes, these indicants can be mistaken for other illnesses as well.
- Feeling tired or fatigued
- Excessive thirst and urination
- Nausea and vomiting
- Abdominal pain
- Signs of dehydration, such as dry mouth and skin
- Rapid, deep, and labored breathing (Kussmaul breathing)
- Fever and unconsciousness
- Loss of appetite or eating disorder
- General weakness and confusion
- Increased heart rate and low blood pressure
- Emanation of a distinctive fruity odor in the breath
- Acute pancreatitis, appendicitis, or gastrointestinal perforation
Small children suffering from ketoacidosis are more prone to cerebral edema (swelling of the brain tissue) that causes headache, coma, loss of pupillary light reflex, and further leads to death. However, these symptoms are rarely found in adults.
Diagnosis and Treatment
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 include chest X-ray, ECG, urine analysis, and if required, a CT scan of the brain.
DKA treatment usually 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 moderate elevations in blood sugar levels are observed, it can be treated with additional injections of a short-acting form of insulin. The most principal and critical treatment for ketoacidosis is intravenous (IV) fluid replacement, which is given through a vein.
Potassium is usually added to IV fluids to compensate for the loss. It reverses the process of 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/dL, extra glucose should be provided to allow continued insulin administration without the development of hypoglycemia.
People diagnosed with DKA are usually admitted to 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 he/she will regularly follow up with the doctor. The key to prevent diabetic ketoacidosis includes close monitoring and control of blood sugar levels, especially during infections, stress, trauma, or other serious illnesses. By taking insulin injections on time and contacting the physician when needed, the patient can live a normal and healthy life.
Disclaimer: This HealthHearty article is for informative purposes only and should not be used as a replacement for expert medical advice.