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diabetic ketoacidosis

Alternative Names

Diabetic ketoacidosis (DKA) is a serious complication of diabetes mellitus (DM), or diabetes. It may occur in some people when their diabetes is not well controlled.

What is going on in the body?
People with diabetes do not produce enough of the hormone insulin to meet their body's needs. Insulin helps the body to regulate glucose, or blood sugar, levels and other aspects of metabolism. DKA is a serious but treatable complication of diabetes. It results in high blood sugar levels and too much acid build up in the body. DKA occurs primarily in those with type 1 diabetes, or insulin-dependent diabetes (Type 1 diabetes). Rarely, it can occur in those with type 2 diabetes, or noninsulin-dependent diabetes mellitus (NType 1 diabetes).

What are the signs and symptoms of the condition?
DKA can cause:
  • high blood sugar levels.
  • excessive thirst.
  • nausea and vomiting.
  • excessive urination, which is an early symptom. As the condition gets worse, the person may stop making urine because of dehydration.
  • weight loss.
  • abdominal pain.
  • a fruity odour of the breath.
  • dehydration.
  • fatigue.
  • confusion.
  • weakness.
  • coma, which may happen if the condition gets severe.
People may also have symptoms of other illnesses that can cause a person with diabetes to develop DKA.

What are the causes and risks of the condition?
DKA commonly occurs in people before they are diagnosed with type 1 diabetes, usually children and young adults. This condition often brings people to see a doctor for their diabetes before it is first diagnosed.

Infection and other serious illnesses can cause DKA to develop. DKA can also develop if a person stops taking their insulin or takes the wrong dose of insulin.

What can be done to prevent the condition?
Knowledge of the early signs and symptoms of new-onset or poorly controlled diabetes can help prevent some cases. These signs and symptoms can include weight loss, fatigue, and excessive thirst and urination. Increased appetite and food intake, weight loss and a general decline in health for no clear reason also commonly occur.

Individuals with diabetes should take their insulin as directed. If a person is unable to eat, they should contact their doctor for advice on how to adjust their insulin. It is not often true that if someone does not eat, they should not take any insulin. This is a common myth among people with diabetes.

People with diabetes are advised to check their blood sugar every day as directed. If the blood sugar is high several times in a row, a person should contact their doctor.

People with diabetes should seek early treatment for infections and other illnesses. People with symptoms of DKA should contact their doctor promptly.

How is the condition diagnosed?
A history and physical examination often suggest the diagnosis. Blood tests can confirm the high glucose level and the build up of acid in the body. Other tests, such as urine or x-ray tests, may aid in diagnosis and help suggest reasons why DKA has occurred.

What are the long-term effects of the condition?
DKA is generally a reversible problem. The main long-term effect of DKA is death, which occurs in a small percentage of people. Brain and other organ damage are rare complications of DKA. An associated severe infection or illness may cause its own complications. Most people recover without any long-term effects.

What are the risks to others?
DKA is not contagious and poses no risks to others.

What are the treatments for the condition?
Treatment is directed at the DKA and the underlying condition that caused DKA, if one is present. For example, antibiotics or surgery may be needed for an infection. Fluids and insulin are generally given through an IV. An IV is a thin tube that is placed into a person's vein, usually in the arm. Salt replacement is also commonly needed through the IV. People often need care in an intensive care unit with frequent monitoring. Treatment may last several hours or several days.

What are the side effects of the treatments?
Getting too much fluid or the wrong kind of fluid can cause swelling of the brain. Low blood sugar is rarely a problem, but may occur if too much insulin is given. Antibiotics, if needed, may cause allergic reactions, stomach upset and other side effects. Specific side effects depend on the drugs used. Other treatments for the underlying cause of DKA may have other side effects.

What happens after treatment for the condition?
People with diabetes need treatment and monitoring for life. Retraining people in how to manage diabetes is often done after recovery from DKA. Education includes information on diet, exercise, insulin dosage, and checking the blood sugar. A person's insulin dose may need to be changed in some cases.

How is the condition monitored?
DKA is a potentially life-threatening condition and generally requires close monitoring. People may need to be in the intensive care unit until they are stable. Repeated blood tests are often needed to follow the blood sugar, salt balance, and level of acid in the body. Other monitoring may be needed depending on why DKA occurred.

Reviewer: HealthAnswers Australia Medical Review Panel
Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia
Last Updated: 1/10/2001
Potential conflict of interest information for reviewers available on request

This website and article is not a substitute for independent professional advice. Nothing contained in this website is intended to be used as medical advice and it is not intended to be used to diagnose, treat, cure or prevent any disease, nor should it be used for therapeutic purposes or as a substitute for your own health professional's advice.  All Health and any associated parties do not accept any liability for any injury, loss or damage incurred by use of or reliance on the information.


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