Diabetic Ketoacidosis (DKA)

Diabetic ketoacidosis (DKA) is a life-threatening blood chemical (electrolyte) imbalance that develops in a person with diabetes when the cells do not get the sugar (glucose) they need for energy. As a result, the body breaks down fat instead of glucose and produces and releases substances called ketones into the…

Diabetic Ketoacidosis (DKA)

Diabetic ketoacidosis (DKA) is a life-threatening blood chemical (electrolyte) imbalance that develops in a person with diabetes when the cells do not get the sugar (glucose) they need for energy. As a result, the body breaks down fat instead of glucose and produces and releases substances called ketones into the bloodstream.

People with type 1 diabetes and some people with type 2 diabetes are at risk for DKA if they do not take enough insulin, have a severe infection or other illness, or become severely dehydrated.

Symptoms of diabetic ketoacidosis include:

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

Severe diabetic ketoacidosis can cause difficulty breathing, brain swelling (cerebral edema), coma, or death.

Treatment involves giving insulin and fluids through a vein and closely monitoring and replacing electrolytes.

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Diabetic Ketoacidosis (DKA)

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 because there is not enough insulin. When the sugar cannot get into the cells, it stays in the blood. The kidneys filter some of…

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 because there is not enough insulin.

When the sugar cannot get into the cells, it stays in the blood. The kidneys filter some of the sugar from the blood and remove it from the body through urine.

Because the cells cannot receive sugar for energy, 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 getting enough insulin, having a severe infection or other illness, becoming severely dehydrated, or some combination of these things. 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, especially children) 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 and urinating a lot.
  • 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, belly pain, and vomiting.
  • Confusion.

How is DKA diagnosed?

Laboratory tests, including blood and urine tests, are used to confirm a diagnosis of diabetic ketoacidosis. Tests for ketones are available for home use. Keep some test strips 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 your vein and closely watching certain chemicals in your blood (electrolytes). The doctors and nurses will watch you closely to be sure that your brain does not swell as the fluids treat your dehydration.

It can take several days for your blood sugar level to return to a target range.

How can I prevent DKA?

The risk for DKA is higher when you are sick. Stress hormones released due to illness can raise your blood sugar. You may be at risk for dehydration if you are vomiting. Or you may not take your diabetes medicine when you don't feel like eating.

To prevent DKA when you are not feeling well, try to drink water, take your diabetes medicine, and eat a little food. Test your blood sugar often. If you are taking insulin, do a test for ketones.

You and your doctor can make your sick day plan before you get sick so you can prevent a DKA emergency or know when to get help.

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References

Other Works Consulted

  • Cooppan R, et al. (2010). Acute complications. In RS Beaser, ed., Joslin's Diabetes Deskbook: A Guide for Primary Care Providers, 2nd ed., pp. 419–443. Boston: Joslin Diabetes Center.
  • Eisenbarth GS, Buse JB (2011). Type 1 diabetes mellitus. In S Melmed et al., eds., Williams Textbook of Endocrinology, 12th ed., pp. 1436–1461. Philadelphia: Saunders.
  • Masharani U, German MS (2011). Pancreatic hormones and diabetes mellitus. In DG Gardner, D Shoback, eds., Greenspan's Basic and Clinical Endocrinology, 9th ed., pp. 573–655. New York: McGraw-Hill.

Credits

Current as ofApril 16, 2019

Author: Healthwise Staff
Medical Review: E. Gregory Thompson MD - Internal Medicine
Adam Husney MD - Family Medicine
Kathleen Romito MD - Family Medicine
Rhonda O'Brien MS, RD, CDE - Certified Diabetes Educator

This information does not replace the advice of a doctor. Healthwise, Incorporated, disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. Learn how we develop our content.