What is considered diabetic ketoacidosis (DKA)?

From the Guidelines

Diabetic ketoacidosis (DKA) is considered a serious complication of diabetes characterized by high blood glucose levels, the presence of ketones in the blood and urine, and metabolic acidosis with a pH less than 7.3, as defined by the most recent guidelines 1.

Key Characteristics of DKA

• High blood glucose levels (typically above 250 mg/dL)
• Presence of ketones in the blood and urine
• Metabolic acidosis with a pH less than 7.3

Diagnosis and Treatment

DKA can occur in people with type 1 or type 2 diabetes, especially during severe stress or illness, and develops when the body cannot produce enough insulin, causing cells to burn fat for energy instead of glucose, which produces ketones that make the blood acidic.

Symptoms

Common symptoms of DKA include:

• Excessive thirst
• Frequent urination
• Nausea
• Vomiting
• Abdominal pain
• Weakness
• Confusion
• Fruity-smelling breath
• Rapid breathing

Management

DKA requires immediate medical attention and is typically treated in a hospital setting with:

• Intravenous fluids
• Insulin therapy
• Electrolyte replacement The underlying cause, such as infection or missed insulin doses, must also be identified and addressed.

Prevention

Regular monitoring of blood glucose levels, consistent insulin administration, and prompt attention to illness can help prevent DKA in people with diabetes, as recommended by recent guidelines 1.

From the FDA Drug Label

In patients with type 1 or insulin-dependent diabetes, prolonged hyperglycemia can result in DKA (a life-threatening emergency) 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.

Diabetic Ketoacidosis (DKA) is considered a life-threatening emergency that can result from prolonged hyperglycemia in patients with type 1 or insulin-dependent diabetes. The symptoms of DKA usually develop gradually over a period of hours or days and may include:

• A drowsy feeling
• Flushed face
• Thirst
• Loss of appetite
• Fruity odor on the breath
• Large amounts of glucose and ketones in blood and urine tests 2

From the Research

Definition of DKA

• Diabetic ketoacidosis (DKA) is considered a hyperglycemic emergency that occurs in people with diabetes mellitus 3, 4, 5, 6, 7.
• A diagnosis of DKA is confirmed when all of the three criteria are present:
  • 'D', either elevated blood glucose levels or a family history of diabetes mellitus 3.
  • 'K', the presence of high urinary or blood ketoacids 3.
  • 'A', a high anion gap metabolic acidosis 3.
• DKA is characterized by hyperglycemia, metabolic acidosis, and ketosis 4, 5, 6, 7.

Key Characteristics

• The triad of uncontrolled hyperglycemia, metabolic acidosis, and increased total body ketone concentration characterizes DKA 6.
• These metabolic derangements result from the combination of absolute or relative insulin deficiency and increased levels of counter-regulatory hormones (glucagon, catecholamines, cortisol, and growth hormone) 6.
• The severity of DKA is classified based on the level of acidosis present rather than absolute glucose level 7.

Precipitating Causes

• The most common precipitating causes for DKA include infections, new diagnosis of diabetes, and nonadherence to insulin therapy 4, 6.
• Other precipitating causes are intercurrent illnesses (i.e., surgery, trauma, myocardial ischemia, pancreatitis), psychological stress, and non-compliance with insulin therapy 6.
• Clinicians should be aware of the occurrence of DKA in patients prescribed sodium-glucose co-transporter 2 inhibitors 4.