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. Common 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)
- High blood sugar levels typically above 250 mg/dL ### Clinical Presentation and Management As DKA progresses, patients may experience dehydration, electrolyte imbalances, particularly potassium, and increasing mental status changes that can lead to coma 1. Physical examination may reveal dry mucous membranes, reduced skin turgor, and hypotension indicating dehydration. The condition develops most commonly in type 1 diabetics but can occur in type 2 diabetes during severe illness or stress. DKA is a medical emergency requiring immediate treatment with insulin, fluids, and electrolyte replacement to prevent potentially life-threatening complications such as cerebral edema, cardiac arrhythmias, or kidney failure 1.
Underlying Mechanism
The underlying mechanism involves insulin deficiency leading to hyperglycemia, which triggers the production of ketone bodies as an alternative energy source, resulting in metabolic acidosis 2.
Key Considerations
Management goals include restoration of circulatory volume and tissue perfusion, resolution of hyperglycemia, and correction of electrolyte imbalance and acidosis 1. It is also essential to treat any correctable underlying cause of DKA, such as sepsis, myocardial infarction, or stroke. In critically ill and mentally obtunded individuals with DKA or hyperosmolar hyperglycemia, continuous intravenous insulin is the standard of care 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 3
From the Research
Symptoms of Diabetic Ketoacidosis (DKA)
The symptoms of DKA can be nonspecific and may include:
- Polyuria and polydipsia, which are the most common symptoms 4
- Nausea, vomiting, abdominal pain, weight loss, severe fatigue, dyspnea, and preceding febrile illness 4
- Fatigue, polydipsia, polyuria, weakness, weight loss, nausea, vomiting, and abdominal pain with tachycardia and tachypnea on exam 5
- General malaise, dyspnea, altered mental status, and abdominal pain 6
- Nausea and vomiting, increased thirst and urine production, hyperglycemia, abdominal pain, shortness of breath, confusion, headache, general weakness, fatigue and increased heart rate 7
- Nausea and vomiting, hypothermia, hypotension, cardiac arrhythmia, tachycardia, deep and rapid breathing 8
Severity of Symptoms
The severity of DKA symptoms can vary, with some cases being more severe than others. Severe DKA can be characterized by:
- A pH level of 6.9 or lower 6
- Altered mental status 6
- Acute renal failure 6
- Cardiac arrhythmia, tachycardia, deep and rapid breathing 8
Importance of Early Recognition
Early recognition of DKA symptoms is crucial for prompt treatment and prevention of complications. Emergency nurses play a critical role in recognizing the signs and symptoms of DKA and providing urgent treatment to reverse ketosis and hyperglycemia 8. A high index of suspicion for DKA is required, especially in patients with nonspecific symptoms 5.