From the Guidelines
Diabetic ketoacidosis (DKA) symptoms include excessive thirst, frequent urination, nausea, vomiting, abdominal pain, weakness, fatigue, confusion, fruity-scented breath, and rapid breathing, and can progress to life-threatening complications if not promptly treated with insulin, fluids, and electrolyte replacement. These symptoms typically develop quickly, often within 24 hours 1. The hallmark signs of DKA are high blood sugar levels (typically above 250 mg/dL), ketones in the urine or blood, and acidosis. As DKA progresses, symptoms can worsen to include decreased consciousness, dehydration with dry skin and mouth, low blood pressure, rapid heartbeat, and in severe cases, coma. DKA occurs when the body cannot use glucose for energy due to insufficient insulin, causing it to break down fat instead, which produces ketones that make the blood acidic. This condition is most common in people with type 1 diabetes but can occur in type 2 diabetes during severe illness or stress.
Key Symptoms and Signs
- Excessive thirst and urination
- Nausea and vomiting
- Abdominal pain
- Weakness and fatigue
- Confusion and altered mental status
- Fruity-scented breath
- Rapid breathing
- High blood sugar levels
- Ketones in the urine or blood
- Acidosis
Treatment and Management
Treatment of DKA involves restoration of circulatory volume and tissue perfusion, resolution of hyperglycemia, and correction of electrolyte imbalance and acidosis 1. Continuous intravenous insulin is the standard of care for critically ill and mentally obtunded patients with DKA or hyperosmolar hyperglycemia. Successful transition from intravenous to subcutaneous insulin requires administration of basal insulin 2–4 h before the intravenous insulin is stopped to prevent recurrence of ketoacidosis and rebound hyperglycemia. Aggressive fluid management and treatment of any underlying cause of DKA, such as sepsis or myocardial infarction, are also crucial.
Prevention of Complications
Prevention of complications, such as cerebral edema, cardiac arrhythmias, and kidney failure, is critical in the management of DKA 1. Gradual replacement of sodium and water deficits, maintenance of a glucose level of 250–300 mg/dL during treatment, and avoidance of rapid declines in plasma osmolality can help prevent cerebral edema. Close monitoring of patients with DKA is essential to promptly identify and treat any complications that may arise.
From the FDA Drug Label
The first symptoms of DKA usually come on gradually, over a period of hours or days, and include a drowsy feeling, flushed face, thirst, loss of appetite, and fruity odor on the breath. Early signs of diabetic ketoacidosis include glycosuria and ketonuria Polydipsia, polyuria, loss of appetite, fatigue, dry skin, abdominal pain, nausea and vomiting and compensatory tachypnea come on gradually, usually over a period of some hours or days, in conjunction with hyperglycemia and ketonemia.
The symptoms of Diabetic Ketoacidosis (DKA) include:
- Drowsy feeling
- Flushed face
- Thirst
- Loss of appetite
- Fruity odor on the breath
- Polydipsia (excessive thirst)
- Polyuria (frequent urination)
- Fatigue
- Dry skin
- Abdominal pain
- Nausea and vomiting
- Compensatory tachypnea (rapid breathing) These symptoms can develop over a period of hours or days and require immediate medical attention 2, 2.
From the Research
DKA Symptoms
- The symptoms of Diabetic Ketoacidosis (DKA) include polyuria, polydipsia, nausea, vomiting, abdominal pain, weight loss, severe fatigue, dyspnea, and preceding febrile illness 3
- Hyperglycemia, metabolic acidosis, and ketosis are the characteristic features of DKA 4, 3, 5
- Infection is the most common precipitating cause of DKA, but stress in any form can lead to metabolic decompensation 6
- The use of sodium-glucose cotransporter-2 inhibitors modestly increases the risk of DKA and euglycemic DKA 3
Common Precipitating Causes
- Infections 6, 5
- New diagnosis of diabetes 5
- Nonadherence to insulin therapy 6, 5
- Stress in any form 6
- Omission of insulin (an unusual cause) 6
Diagnosis and Treatment
- Diagnosis of DKA is confirmed when all three criteria are present: elevated blood glucose levels or a family history of diabetes mellitus, the presence of high urinary or blood ketoacids, and a high anion gap metabolic acidosis 4
- Treatment involves fluid and electrolyte replacement, insulin, treatment of precipitating causes, and close monitoring to adjust therapy and identify complications 4, 3, 5