Diabetic ketoacidosis
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Diabetes-related ketoacidosis (DKA) is a severe and potentially life-threatening complication that can occur in individuals with diabetes or those with undiagnosed diabetes. This condition arises when the body is unable to produce an adequate amount of insulin. Insulin is crucial in facilitating the entry of sugar, a primary energy source for muscles and other tissues, into cells.
In the absence of sufficient insulin, the body resorts to breaking down fat for energy, resulting in the accumulation of acids known as ketones in the bloodstream. If left unaddressed, this buildup can progress to diabetic ketoacidosis.
For a person with diabetes, elevated ketone levels lead to an acidic blood environment, characterized by a low blood pH. This situation constitutes a medical emergency, necessitating prompt attention and treatment.
Symptoms
Diabetic ketoacidosis (DKA) symptoms can develop rapidly, often appearing within 24 hours. In some cases, these symptoms may be the initial indicators of diabetes. Look out for:
- Frequent urination: Needing to urinate often.
- Excessive thirst: Feeling very thirsty.
- Weakness and fatigue: Feeling overall weakness or tiredness.
- Shortness of breath: Having difficulty breathing.
- Abdominal pain: Experiencing stomach pain.
- Fruity breath odor: Breath smelling fruity.
- Confusion: Experiencing confusion or mental fog.
- Nausea and vomiting: Feeling the urge to throw up and actually vomiting.
More definitive signs of diabetic ketoacidosis, which can be detected using home blood and urine test kits, include:
1. High blood sugar: Elevated blood sugar levels.
2. Increased ketones in urine: Higher-than-normal ketone levels in the urine.
If you’re feeling unwell or stressed, monitor your blood sugar regularly, and consider a urine ketone test from a drugstore. Contact your healthcare provider immediately if you’re vomiting uncontrollably, if your blood sugar remains high despite home treatment, or if urine ketone levels are moderate or high.
Seek emergency care if your blood sugar consistently exceeds 300 mg/dL (16.7 mmol/L), you have ketones in your urine and can’t reach your healthcare provider, or you’re experiencing severe symptoms of diabetic ketoacidosis such as excessive thirst, frequent urination, nausea, vomiting, stomach pain, weakness, shortness of breath, fruity-scented breath, or confusion. Remember, untreated diabetic ketoacidosis can be fatal.
Causes
Sugar serves as a primary energy source for cells comprising muscles and tissues, facilitated by insulin, which enables sugar entry into the cells. Insufficient insulin prevents the body from utilizing sugar for energy production, leading to the release of hormones that break down fat as an alternative fuel source. This process generates ketones, and their accumulation in the blood eventually spills into the urine.
Usually, diabetic ketoacidosis follows:
- A disease. The body may produce increased amounts of some hormones, such as cortisol or adrenaline, in response to an infection or other sickness. These hormones can occasionally result in diabetic ketoacidosis and act counter to the actions of insulin. Diabetic ketoacidosis is frequently caused by common ailments such as pneumonia and urinary tract infections.
- Irregularities in insulin treatment. Too little insulin may remain in the body as a result of missed insulin injections. Too little insulin in the body might also result from inadequate insulin therapy or an inefficient insulin pump. Diabetic ketoacidosis can be caused by any of these issues.
Additional factors that may result in diabetic ketoacidosis include:
- Pancreatitis
- Heart attack or stroke
- Physical or emotional injury
- Abuse of alcohol or drugs, especially cocaine
- A few medications, including certain diuretics and corticosteroids
- Pregnancy
Risk factors
The highest risk of diabetic ketoacidosis is associated with individuals who have type 1 diabetes or frequently miss insulin doses. Although less common, diabetic ketoacidosis can also occur in some cases of type 2 diabetes, and, on occasion, it may serve as the initial indication of diabetes.
Diagnosis
Diagnosis of diabetes-related ketoacidosis (DKA) typically involves assessing four key conditions:
- Blood glucose level exceeding 250 mg/dL. (Note: Euglycemic diabetes-related ketoacidosis [euDKA], with blood sugar below 250, is less common.)
- Blood pH below 7.3, indicating acidosis.
- Presence of ketones in urine and/or blood.
- Serum bicarbonate level below 18 mEq per L.
In a hospital setting, healthcare professionals may employ various tests for DKA diagnosis, including:
- Blood glucose testing.
- Ketone testing via urine or blood analysis.
- Arterial blood gas analysis.
- Basic metabolic panel evaluation.
- Blood pressure measurement.
- Osmolality blood testing.
Treatment
If diagnosed with diabetic ketoacidosis, emergency room treatment or hospital admission is common. The typical approach involves:
- Fluid administration: Fluids are administered to replenish those lost due to excessive urination. This aids in diluting elevated blood sugar levels. Fluids can be administered orally or intravenously (IV).
- Insulin therapy: Insulin is a key component in reversing diabetic ketoacidosis. Alongside fluids and electrolytes, insulin is typically administered through a vein. Transitioning back to regular insulin therapy becomes feasible when blood sugar levels drop to around 200 mg/dL (11.1 mmol/L), and the blood’s acidity is normalized.
- Electrolyte replacement: Electrolytes, such as sodium, potassium, and chloride, play a crucial role in maintaining the body’s electric balance. In cases of insufficient insulin, electrolyte levels can drop. IV electrolyte replacement is employed to ensure proper functioning of the heart, muscles, and nerve cells.
