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 if left untreated, can progress to life-threatening complications such as cerebral edema, hypoxemia, and noncardiogenic pulmonary edema 1.
Key Symptoms
- Excessive thirst and frequent urination
- Nausea and vomiting
- Abdominal pain
- Weakness and fatigue
- Confusion and fruity-scented breath
- Rapid breathing, which can progress to Kussmaul breathing (deep, labored breathing)
Early Warning Signs
- Very high blood glucose levels (typically above 250 mg/dL)
- Dehydration
- Presence of ketones in urine
Treatment and Management
DKA is a medical emergency requiring immediate hospital treatment with IV fluids, insulin therapy, and electrolyte replacement 1. The management goals include restoration of circulatory volume and tissue perfusion, resolution of hyperglycemia, and correction of electrolyte imbalance and acidosis. It is also important to treat any correctable underlying cause of DKA such as sepsis, myocardial infarction, or stroke.
Prevention of Complications
Prevention measures that might decrease the risk of cerebral edema in high-risk patients include gradual replacement of sodium and water deficits in patients who are hyperosmolar and the addition of dextrose to the hydrating solution once blood glucose reaches 250 mg/dL 1.
Importance of Prompt Treatment
Anyone experiencing these symptoms, especially those with diabetes, should seek emergency medical care immediately as DKA can be life-threatening if not promptly treated 1.
From the Research
DKA Symptoms
- Hyperglycemia
- Metabolic acidosis
- Ketosis 2
Precipitating Causes of DKA
- Infections
- New diagnosis of diabetes
- Nonadherence to insulin therapy
- Sodium-glucose co-transporter 2 inhibitors 2
Management of DKA
- Hospitalization
- Aggressive intravenous fluids
- Insulin therapy
- Electrolyte replacement
- Identification and treatment of the underlying precipitating event
- Frequent monitoring of patient's clinical and laboratory states 2
- Fluid resuscitation with balanced electrolyte solutions may result in faster resolution of DKA than with 0.9% saline in adults 3
Prevention of DKA
- Patient education programs focusing on adherence to insulin and self-care guidelines during illness
- Improved access to medical providers
- New approaches such as extended availability of phone services, use of telemedicine and utilization of public campaigns 2