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What is Diabetic Ketoacidosis ?

It  is a harmful complication of diabetes that results due to excessively large amounts of blood acids production by the body. The blood acids are called ketones.

It is important for diabetic patients to know about the warning signs of diabetic ketoacidosis, so as to seek immediate emergency medical attention.

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Diabetic Ketoacidosis Pathophysiology

Diabetic ketoacidosis occurs when the levels of insulin in the body decreases to very low levels. Insulin performs the vital function of allowing the glucose or sugar to enter the cells in the body. Glucose is an essential source of energy for the various tissues of the body, especially the muscles. Low levels of insulin result in the breakdown of fat by the body as a substitute for energy production. This process results in the production of toxic acids called ketones, which are released into the blood stream and can ultimately result in diabetic ketoacidosis, if left untreated.

DKA Lab Values

There is a rise in blood glucose level higher than 250 mg/dl (althugh the test usually indicate a much higher figure), arterial blood pH less than 7.3 and serum concentration of ketones more than 5 mEq/L. The serum bicarbonate level of 18 mEq/L or less with the figure of < 5 mEq/L indicates severe DK.

Symptoms of diabetic Ketoacidosis

The signs and symptoms of diabetic ketoacidosis may a rapid appearance, usually within a period of 24 hours. Some of the symptoms include:

  • Increased thirst
  • Vomiting and nausea
  • Persistent urination
  • Pain in the abdomen
  • Fatigue, exhaustion or weakness
  • Appetite loss
  • Breathlessness or shortness of breath
  • Disorientation or confusion
  • The breath may have a fruity odor

Home urine and blood test kits may be able to detect the more specific symptoms of diabetic ketoacidosis such as

  • High levels of blood sugar
  • High levels of ketone in the urine

The symptoms of diabetic ketoacidosis may be similar to those elicited by the flu and hence it can be problematic to determine whether the signs indicate the presence of an infection or some other serious disorder. It is important for diabetic patients to regularly check the blood sugar levels, when they have been recently ill or are feeling unwell. The ketone levels in the urine may also be checked with the aid of the home kits.

Treatment of diabetic ketoacidosis involves administration of fluids and electrolytes such as potassium, sodium and chloride. Some of the common complications usually result due to engaging in such forms of treatment:

  • Hypokalemia or low potassium: The use of insulin and fluids to treat cases of diabetic ketoacidosis can cause the levels of potassium to drop to very low levels. This can result in impairment of the muscle, cardiac and nerve functions.
  • Hypoglycemia or low levels of blood sugar:  The entry of sugar into the cells is facilitated by insulin, which then results in decrease of blood sugar levels. A rapid drop in the levels of blood sugar can cause low blood sugar levels.
  • Cerebral edema or brain inflammation or swelling: The rapid adjustment of blood sugar levels in the body can lead to swelling in the brain. The development of such a complication of diabetic ketoacidosis usually occurs in children, particularly those who have been newly detected with diabetes.

Causes of Diabetic Ketoacidosis

Sugar is the most common source of energy available for the muscles cells and other tissues in the body. Sugars usually gain entry into the cells with the aid of insulin. The lack of sufficient levels of insulin in the body, prevents the body from using insulin to make energy. This leads to the secretion of certain hormones by the body, which aids it in the conversion of fat as an alternate source of energy. Such an abnormal process results in the formation of ketones, which are then released into the blood stream. The collection of increased amounts of such toxic acids in the blood then leads to it being then eliminated via the urine.

The various triggers of diabetic ketoacidosis are as follows:

  • Insulin therapy problems such as deficient insulin therapy or missed treatments with insulin can result in decreased levels of insulin in the blood prompting the occurrence of diabetic ketoacidosis
  • The presence of an illness or other types of infection can trigger the production of certain hormones like adrenaline by the body. It may be noted that such hormones counter the effect of insulin resulting in the occurrence of diabetic ketoacidosis. Some of the most common causes are urinary tract infections and pneumonia

Some of the other factors that may trigger an episode of diabetic ketoacidosis include:

  • Stress
  • High fever
  • Emotional or physical trauma
  • Surgery
  • Stroke
  • Cardiac arrest
  • Abuse of drugs or alcohol

Diabetic ketoacidosis Treatment

Diabetic ketoacidosis can result in the loss of consciousness and can result in a fatality, if left untreated. Hence, immediate medical attention and hospitalization is required to treat the condition. Treatment of diabetic ketoacidosis involves the three steps:

  • Low or absent levels of insulin in the body can cause the electrolyte levels to drop. Hence, intravenous administration of electrolytes is necessary to allow the normal functioning of the nerve, muscle and cardiac cells.
  • Oral or intravenous administration of fluids is need till the patient’s body becomes rehydrated. It will also aid the dilution of excess blood sugar levels
  • Intravenous insulin therapy is required to reverse the affects of diabetic ketoacidosis, till the toxic acid content in the blood is normalized and the blood sugar levels drop to below 240 mg/dL.

Once the condition is normalized, the doctor will diagnose the underlying cause of the condition and additional treatments will be given.


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