From the Guidelines
Diabetic ketoacidosis (DKA) is characterized by symptoms including nausea, vomiting, Kussmaul respirations, dehydration, and altered mental status, as a result of absolute or relative insulin deficiency leading to fat breakdown and acidosis 1.
Symptoms of DKA
The symptoms of DKA can vary in severity and presentation, ranging from mild hyperglycemia and acidosis to severe hyperglycemia, dehydration, and coma 1. The main symptoms include:
- Nausea and vomiting
- Kussmaul respirations (rapid breathing)
- Dehydration
- Altered mental status
- Excessive thirst and frequent urination
- Abdominal pain
- Weakness or fatigue
- Confusion
- Fruity-scented breath (from ketones)
Diagnosis and Treatment
DKA is diagnosed based on the presence of hyperglycemia, metabolic acidosis, and ketosis 1. Treatment goals include restoration of circulatory volume and tissue perfusion, resolution of hyperglycemia, and correction of electrolyte imbalance and acidosis 1. The use of continuous intravenous insulin is the standard of care for critically ill and mentally obtunded patients with DKA or hyperosmolar hyperglycemia 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.
Management
Management of DKA involves individualization of treatment based on a careful clinical and laboratory assessment 1. It is also essential to treat any correctable underlying cause of DKA, such as sepsis, myocardial infarction, or stroke 1. There is no significant difference in outcomes for intravenous human regular insulin versus subcutaneous rapid-acting analogs when combined with aggressive fluid management for treating mild or moderate DKA 1.
From the FDA Drug Label
Hyperglycemia (too much glucose in the blood) may develop if your body has too little insulin ... 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. Heavy breathing and a rapid pulse are more severe symptoms If uncorrected, prolonged hyperglycemia or DKA can lead to nausea, vomiting, stomach pain, dehydration, loss of consciousness, or death.
The symptoms of Diabetic Ketoacidosis (DKA) include:
- A drowsy feeling
- Flushed face
- Thirst
- Loss of appetite
- Fruity odor on the breath
- Heavy breathing
- Rapid pulse
- Nausea
- Vomiting
- Stomach pain
- Dehydration
- Loss of consciousness
- Death 2
From the Research
Symptoms of Diabetic Ketoacidosis (DKA)
The symptoms of DKA can vary, but common symptoms include:
- Polyuria and polydipsia, which are the most common symptoms 3
- Nausea, vomiting, abdominal pain, weight loss, severe fatigue, dyspnea, and preceding febrile illness 3
- Malaise, fatigue, and Kussmaul's respiration 4
- Hypothermia, hypotension, cardiac arrhythmia, tachycardia, deep and rapid breathing 5
- Cerebral oedema, coma, and death if left untreated 5
Euglycemic Diabetic Ketoacidosis
Euglycemic DKA is a rare condition where the blood glucose level may be relatively normal, but the patient still develops ketoacidosis 4. The presentation of patients with euglycemic DKA includes similar symptoms to DKA, such as nausea, vomiting, malaise, fatigue, and Kussmaul's respiration 4.
Diagnostic Considerations
DKA can be diagnosed by the triad of hyperglycemia, metabolic acidosis, and elevated serum or urine ketones 3. However, hyperglycemia has been de-emphasized in recent guidelines due to the increasing incidence of euglycemic DKA 3. Other diagnostic considerations include electrolytes, phosphate, blood urea nitrogen, creatinine, urinalysis, complete blood cell count with differential, A1C, and electrocardiography 3.
Infection and DKA
Infection is one of the most common triggers of DKA, and the presence of infection can increase the mortality rate 6. The symptoms and biomarkers of DKA are similar to those of infection, making diagnosis challenging 6. Researching possible diagnostic tools for the presence of infection in DKA patients is essential to ensure appropriate management and prevent antimicrobial resistance 6.