What are the symptoms of Diabetic Ketoacidosis (DKA)?

Symptoms of Diabetic Ketoacidosis (DKA)

Diabetic ketoacidosis (DKA) typically presents with polyuria, polydipsia, weight loss, dehydration, nausea, vomiting, abdominal pain, and Kussmaul respiration, developing over hours to days. 1

Classic Clinical Presentation

• DKA develops over hours to days, unlike Hyperglycemic Hyperosmolar State (HHS) which develops over days to weeks 1
• Patients with DKA are usually alert, though mental status can deteriorate as the condition worsens 1
• Polyuria (excessive urination), polydipsia (excessive thirst), and weight loss are cardinal symptoms of DKA 1
• Dehydration is a common physical finding due to osmotic diuresis from hyperglycemia 1
• Nausea, vomiting, and abdominal pain are present in many patients with DKA and may mimic an acute abdomen 1
• Kussmaul respiration (deep, rapid breathing) is characteristic of DKA and represents respiratory compensation for metabolic acidosis 1

Early Warning Signs

• The first symptoms of DKA usually develop gradually over hours to days 2
• Early symptoms include drowsy feeling, flushed face, thirst, loss of appetite, and fruity odor on the breath (due to acetone) 2
• Blood glucose levels typically exceed 250 mg/dL (13.9 mmol/L), though euglycemic DKA (glucose <200 mg/dL) can occur in approximately 10% of cases, especially during pregnancy or with SGLT2 inhibitor use 1, 3
• Urine and blood tests show elevated glucose and ketones 2

Advanced Symptoms

• Heavy breathing (Kussmaul respiration) and rapid pulse indicate worsening DKA 2
• If uncorrected, DKA progresses to more severe symptoms including stomach pain, dehydration, loss of consciousness, or death 2
• Altered mental status may develop as acidosis worsens 4, 2
• Hypotension can occur due to severe dehydration 4, 5
• Hypothermia may be present despite infection 5
• Cardiac arrhythmias can develop, particularly related to electrolyte disturbances 5

Special Considerations

• Euglycemic DKA (blood glucose <200 mg/dL) can occur in approximately 10% of DKA cases, particularly during pregnancy, with SGLT2 inhibitor use, reduced food intake, alcohol use, or liver failure 1, 3
• Pregnant individuals may present with euglycemic DKA, and diagnosis may be complicated by mixed acid-base disturbances, especially with hyperemesis 1
• About 50% of DKA cases are triggered by infections, particularly urinary tract infections and pneumonia 6
• DKA symptoms may overlap with other conditions such as pneumonia, asthma exacerbation, urinary tract infection, gastroenteritis, acute abdomen, and central nervous system infections 7

When to Seek Immediate Medical Attention

• Patients should seek immediate medical attention if they are unable to tolerate oral hydration, blood glucose levels do not improve with insulin administration, altered mental status is present, or any signs of worsening illness occur 1
• DKA is a medical emergency that requires prompt treatment to prevent progression to coma and death 2
• Individuals concerned about or experiencing DKA should contact their diabetes care team immediately 1

Early recognition of DKA symptoms and prompt treatment are essential to reduce morbidity and mortality associated with this serious diabetes complication.