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, which can develop quickly, often within 24 hours, and require immediate medical attention to prevent morbidity and mortality. The hallmark signs of DKA are high blood sugar levels (typically above 250 mg/dL), ketones in the urine or blood, and acidosis, as noted in the 2023 standards of care in diabetes 1.
Key Symptoms and Signs
- Excessive thirst and frequent urination
- Nausea and vomiting
- Abdominal pain
- Weakness and fatigue
- Confusion and altered mental status
- Fruity-scented breath
- Rapid breathing
- Dry mucous membranes and reduced skin elasticity due to dehydration
- Low blood pressure and rapid heart rate
Pathophysiology and Treatment
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, as explained in the 2021 standards of medical care in diabetes 1. This condition is a medical emergency requiring immediate treatment with IV fluids, insulin, and electrolyte replacement. The management goals include restoration of circulatory volume and tissue perfusion, resolution of hyperglycemia, and correction of electrolyte imbalance and acidosis, with individualization of treatment based on a careful clinical and laboratory assessment 1.
Prevention and High-Risk Groups
People with type 1 diabetes are most susceptible to DKA, but it can also occur in type 2 diabetes during severe illness or stress, highlighting the importance of regular blood sugar monitoring and adherence to insulin therapy to prevent this dangerous complication 1. 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 1.
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. With DKA, blood and urine tests show large amounts of glucose and ketones. Heavy breathing and a rapid pulse are more severe symptoms
- DKA symptoms include:
- Drowsy feeling
- Flushed face
- Thirst
- Loss of appetite
- Fruity odor on the breath
- Heavy breathing
- Rapid pulse If uncorrected, prolonged hyperglycemia or DKA can lead to nausea, vomiting, stomach pain, dehydration, loss of consciousness, or death. Therefore, it is important that you obtain medical assistance immediately 2.
From the Research
DKA Symptoms
- Common symptoms of diabetic ketoacidosis (DKA) include:
- DKA can occur in persons of all ages, with the highest percentage of cases occurring in persons younger than 30 years 3
- The case fatality rate for DKA is 1 to 5 percent 3
Diagnosis and Treatment
- Measurement of A1C, blood urea nitrogen, creatinine, serum glucose, electrolytes, pH, and serum ketones can help diagnose DKA and differentiate it from other metabolic syndromes 3
- Appropriate treatment for DKA includes administering intravenous fluids and insulin, and monitoring glucose and electrolyte levels 3, 4, 5, 6, 7
- Cerebral edema is a rare but severe complication of DKA that can occur predominantly in children 3, 4
Precipitating Factors
- Common precipitating factors for DKA include infections, new diagnosis of diabetes, and nonadherence to insulin therapy 5, 6
- Clinicians should be aware of the occurrence of DKA in patients prescribed sodium-glucose co-transporter 2 inhibitors 5
Management and Prevention
- Proper management of DKA requires hospitalization for aggressive intravenous fluids, insulin therapy, electrolyte replacement, and identification and treatment of the underlying precipitating event 5, 6
- Discharge plans should include appropriate choice and dosing of insulin regimens and interventions to prevent recurrence of DKA 5, 6
- Patient education programs focusing on adherence to insulin and self-care guidelines during illness can help reduce future episodes of DKA 5