• Diabetic Ketoacidosis

    (Diabetic Coma; DKA)

    Definition

    Diabetic ketoacidosis (DKA) occurs when a person’s blood glucose is too high because there is not enough insulin. Instead, the body starts to burn fat for energy. Fat is broken down into acids, causing acid levels to build up in the blood. These acids appear in urine and blood as ketones. DKA is a serious condition that can lead to coma or death if it is not promptly treated.

    Causes

    DKA is most often caused by uncontrolled type 1 diabetes and sometimes type 2 diabetes.

    Risk Factors

    Factors that may increase your risk of DKA:
    • Not taking insulin as prescribed or not taking insulin at all
    • Developing type 1 diabetes for the first time
    • Gastroenteritis with persistent vomiting
    • New infection that may not be obvious, such as pneumonia, urinary tract infection, or sepsis
    • Heart disease, such as heart attack
    • Recent stroke
    • Pregnancy
    • Surgery
    • Some medications, such as steroids or antipsychotic drugs
    • Recreational drug use, such as cocaine
    • Blood clot to the lungs
    • Significant illness or trauma

    Symptoms

    DKA may cause:
    • High blood glucose levels (greater than 250 mg per dL)
    • Dry mouth and skin
    • Thirst
    • Frequent urination
    Symptoms that require emergency care include:
    • Severe stomach pain
    • Rapid or difficult breathing
    • Drowsiness
    • Vomiting and nausea
    • Fruity breath odor
    • Rapid pulse
    • Headache

    Diagnosis

    You will be asked about your symptoms and medical history. A physical exam will be done. Blood and urine tests will be done.
    • Blood and urine will be checked for ketones.
    • The levels of glucose and other substances in your blood will be tested.
    • An arterial blood sample will be taken to test the amount of acid in your blood. This will determine how severe your DKA is.
    • Tests for infection may also be done.
    An electrocardiogram (EKG) may also be done to check your heart's electrical activity.

    Treatment

    DKA is treated with insulin, fluids, and minerals. This may require treatment in an intensive care unit.
    Fluids and electrolytes will be given through IV to help your blood restore balance.
    Insulin may be given by IV or injections. The insulin will immediately start reversing the cycle causing DKA. 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.
    Close monitoring, exams, and blood tests will be needed during treatment
    You may need additional treatment, such as antibiotics, if a bacterial infection is suspected.
    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 DKA. 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.
    • Drink plenty of fluids throughout the day.
    • 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 sugar-free and caffeine-free fluids
    • Do not exercise until your glucose is in balance again

    RESOURCES

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

    National Institute of Diabetes and Digestive and Kidney Diseases http://www.niddk.nih.gov

    CANADIAN RESOURCES

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

    Public Health Agency of Canada http://www.phac-aspc.gc.ca

    References

    Diabetic ketoacidosis (DKA) in adults. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T115027/Diabetic-ketoacidosis-DKA-in-adults. Updated August 23, 2017. Accessed August 25, 2017.

    Diabetic ketoacidosis. Family Doctor website. Available at: https://familydoctor.org/condition/diabetic-ketoacidosis/. Updated June 2017. Accessed August 25, 2017.

    Westerberg D. Diabetic ketoacidosis: Evaluation and treatment. Am Fam Physician. 2013;87(5):337-346.

    Wolfsdorf J, et al. ISPAD Clinical Practice Consensus Guidelines 2014. Diabetic ketoacidosis and hyperglycemic hyperosmolar state. Pediatr Diabetes. 2014 Sep;15 Suppl 20:154-79.

    Revision Information

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