Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a medical emergency that can occur in people with diabetes. It occurs when the body cannot use sugar (glucose) as a fuel source because there is deficiency of insulin. Fat is used for fuel instead. Byproducts of fat breakdown, called ketones, build up in the body. Ketone bodies are acidic in nature and their accumulation shifts the pH of blood towards acidic range.
By definition DKA is characterized by the triad of
1. Uncontrolled hyperglycemia (high blood glucose)
2. Metabolic acidosis
3. Increased total body ketone concentration.

Causes and Risk Factors

DKA results from the combination of absolute or relative insulin deficiency and an increase in counterregulatory hormones (glucagon, catecholamines, cortisol, and growth hormone). Most patients with DKA have type 1 diabetes; however, patients with type 2 diabetes are also at risk during the stress of acute illness such as trauma, surgery, or infections.

Common causes or precipitating factors

• Omission of Insulin dose
• Inadequate insulin dose
• Infections
• Heart attack
• Stroke
• Use of drugs like steroids, antipsychotic drugs, phenytoin, etc.
• Can be first manifestation of type 1 diabetes
• Previously blockage of continuous insulin pumps (unlikely with modern pumps)

When to suspect?

Usually occurs in the setting of uncontrolled blood glucose (the person might complain of history of polyuria, polydipsia and weight loss in the preceding days).

• Blood glucose is usually more than 250 mg/dL
• Infections in persons with type 1 diabetes
• Vomiting and abdominal pain
• Dehydration
• Rapid breathing
• Fruity odour in breath
• Extreme fatigue and drowsiness – can progress to coma

Common clinical features

• Low blood pressure
• Increased pulse rate
• Increased respiratory rate
• Dry skin and mouth
• Mental status can vary from full alertness to profound lethargy or coma

Treatment

The goal of treatment is to correct the high blood sugar level with insulin. Another goal is to replace fluids lost through urination and vomiting.
Most of the time, the person will need to go to the hospital, where the following will be done:

• Insulin replacement
• Fluid and electrolyte replacement
• The cause of the condition (such as infection) will be found and treated
• Someone with diabetes may be able to spot the early warning signs and make changes at home before the condition gets worse. It is important to stay in close touch with the doctor.

Early warning signs

Loss of appetite, nausea and vomiting, abdominal pain, fatigue

Early corrective changes at home (Only to be underatken in close consultation with the doctor)

• Check blood glucose with glucometer
• Check urine ketones with dip stick
• Increase water intake
• An additional dose of short acting insulin can be injected in consultation with the doctor