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Diabetic Ketoacidosis

(Diabetic Coma; DKA)

Definition

Diabetic ketoacidosis is a high level of ketones in the blood. Ketone is an acid that is made when fat is broken down for fuel. A certain level of ketones is normal but excessive levels can make you very sick.
Ketoacidosis is a serious condition that can lead to coma or death if not treated.

Causes

Glucose is the most common source of fuel for the body. A hormone called insulin helps the body use glucose. If insulin is low or missing, the body cannot use glucose for fuel. Fat is used as the main source of fuel in place of glucose. The increased use of fat creates a toxic level of ketones in the blood. Ketones that are high in the blood will also spill over into the urine.
This situation is most often cause by type 1 diabetes and sometimes type 2 diabetes.

Risk Factors

Factors that may increase your risk of ketoacidosis include have diabetes (type 1 or 2) and:

Symptoms

Symptoms of ketoacidosis may include:
  • High blood glucose levels (greater than 250 mg per dL)
  • Dry mouth and skin
  • Thirst
  • Urinating often
Call for emergency medical help or have someone take you to the nearest emergency room if you have:
  • Drowsiness
  • Vomiting and nausea
  • Severe stomach pain
  • Trouble breathing
  • Fruity breath odor
  • Rapid pulse

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done. A urine test will be done to look for the presence of ketones. Blood tests will also be done to:
  • Look for ketones
  • Measure blood glucose level
  • Check pH levels of the blood

Treatment

Ketoacidosis is treated with insulin and fluids.
Insulin may be given by IV or injections. The insulin will immediately start reversing the cycle causing ketoacidosis. The insulin will let the body use glucose for fuel again. Fat will not be needed for fuel so new ketones will not be made. The body will then be able to get rid of the extra ketones.
Fluids and electrolytes will also be given through IV. Fluids will help flush the ketones from your body. Electrolytes will help your blood restore balance.
IV Being Placed in Hand
IV insertion
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Prevention

You and your doctor will make a plan to manage your diabetes. These steps will also reduce the chance of ketoacidosis. Steps may include:
  • Take your insulin as recommended. Always have insulin available. Plan ahead for refills.
  • Monitor your blood glucose level as recommended, generally at least 3-4 times per day. Monitor more often when you are sick or you have high blood glucose levels.
  • Check for ketones in your urine if you have a high blood glucose reading or are ill.
  • Create a sick day plan that may include changes in insulin dose and what to do if you are having trouble eating.
  • See your doctor if you have infection, cough, sore throat, or pain when you urinate.
If your blood glucose is high and you have moderate amounts of ketones in your urine:
  • Contact your doctor.
  • Increase your insulin as recommended.
  • Eat foods that are low in carbohydrates.
  • Drink plenty of fluids (sugar-free and caffeine-free).
  • Do not exercise until your glucose is in balance again.

RESOURCES

American Diabetes Association http://www.diabetes.org/

National Diabetes Information Clearinghouse http://diabetes.niddk.nih.gov/

CANADIAN RESOURCES

Canadian Diabetes Association http://www.diabetes.ca/

Team Diabetes Canada Canadian Diabetes Association www.diabetes.ca/

References

Diabetic ketoacidosis. American Diabetes Association website. Available at: http://www.diabetes.org/living-with-diabetes/complications/ketoacidosis-dka.html. Accessed June 13, 2013.

Diabetic ketoacidosis. American Family Physician Association website. Available at: http://www.aafp.org/afp/2005/0501/p1705.html. Updated May 1, 2005. Accessed June 13, 2013.

Diabetic ketoacidosis (DKA). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated January 12, 2013. Accessed June 13, 2013.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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