Diabetic Ketoacidosis

Diabetic ketoacidosis, or DKA, is a condition in which the body has a severe deficiency of insulin. Insulin is a hormone that helps regulate the level of glucose in the blood. Glucose is the main form of sugar in the body. DKA is a serious complication of diabetes.

What is going on in the body?

Diabetes ketoacidosis is a serious but treatable complication of diabetes. A person who has DKA has a significant deficiency of insulin in his or her body. Without insulin, the body is unable to move glucose from the bloodstream to the body cells. This results in high levels of glucose and acids in the blood. DKA occurs mainly in those who have type 1 diabetes. Rarely, it can occur in those who have type 2 diabetes.

What are the causes and risks of the condition?

DKA often occurs in children and young adults before they are diagnosed with type 1 diabetes. The symptoms of DKA often cause people to see a healthcare provider even before they are diagnosed with diabetes. DKA can also occur if a person with diabetes fails to take the right amount of insulin at the right time. It is seen more often in people younger than the age of 19, but can occur in anyone who has diabetes.

Forty percent of the time, DKA is caused by an infection. Urinary tract infections are the most common of these. Following are some other causes of DKA:

What are the signs and symptoms of the condition?

Early signs of DKA include the classic signs of high blood glucose:

As the person's blood glucose level continues to rise, more symptoms may occur, such as:

If the DKA progresses, the person may fall into a coma.

People may also have symptoms of an underlying infection, such as the following:

How is the condition diagnosed?

The diagnosis of diabetic ketoacidosis begins with a medical history and physical exam. Blood glucose tests can monitor the effect of insulin on the body. The provider may order blood and urine tests to detect underlying infection or illness.

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 may include the following:

People who have diabetes should take their insulin as directed. If a person is unable to eat, the healthcare provider should be contacted. He or she can give advice about insulin dosages.

People with diabetes are advised to check their blood glucose level regularly, as instructed by the healthcare provider. If the blood glucose level is high several times in a row, a person should contact the provider. It is important to seek early treatment for infections and other illnesses. Blood glucose levels need to be checked even more carefully when the person is not well.

What are the long-term effects of the condition?

DKA is generally a reversible problem, resulting in death only 2% of the time. Children with DKA are at high risk for death from cerebral edema, or brain swelling. In fact, DKA causes 70% of diabetes-related deaths in children younger than 10 years of age. Damage to the brain and other organs is a rare complication of DKA. However, 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 any underlying conditions. For example, antibiotics or surgery may be needed for an infection. Fluids and insulin are generally given through an intravenous line, or 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 and is supplied 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, known as cerebral edema. A low blood glucose level is rarely a problem, but may occur if too much insulin is given. Antibiotics may cause allergic reactions, stomach upset, and other side effects.

What happens after treatment for the condition?

People who have diabetes need lifelong treatment. After an episode of DKA, the individual may need further instruction about diabetes. Education includes information on diet, exercise, insulin dosage, and blood glucose monitoring. A person's insulin dose may need to be changed in some cases.

How is the condition monitored?

The individual may have frequent visits with the healthcare provider until the diabetes is well controlled. Any new or worsening symptoms should be reported to the provider.

Author:Thomas Fisher, MD
Date Written:
Editor:Ballenberg, Sally, BS
Edit Date:09/30/01
Reviewer:Eileen McLaughlin, RN, BSN
Date Reviewed:09/11/01