Most Common Complaints in Diabetic Ketoacidosis
The most common complaints in diabetic ketoacidosis are polyuria and polydipsia, followed by nausea, vomiting, abdominal pain, weight loss, and severe fatigue. 1
Primary Presenting Symptoms
Gastrointestinal Manifestations
- Nausea and vomiting are among the most frequent complaints, with vomiting reported in approximately 50% of cases 2
- Abdominal pain is a common presenting symptom that can be severe enough to mimic an acute surgical abdomen 3, 1
- Up to 25% of patients may experience coffee-ground emesis 3
Classic Hyperglycemic Symptoms
- Polyuria (excessive urination) and polydipsia (excessive thirst) are the most common initial symptoms as the body attempts to eliminate excess glucose 1
- Polyphagia (excessive hunger) with paradoxical weight loss frequently occurs 3
- These symptoms typically evolve rapidly, usually within less than 24 hours 3
Constitutional Symptoms
- Generalized weakness is reported in approximately 44.5% of cases 2
- Severe fatigue and malaise are frequently reported 3, 1
- Weight loss occurs as the body breaks down fat and muscle for energy in the absence of effective insulin action 3, 1
Physical Examination Findings
Respiratory Manifestations
- Dyspnea (shortness of breath) is a common complaint as patients develop compensatory hyperventilation 1
- Kussmaul respirations (deep, labored breathing) indicate severe metabolic acidosis, though this is a physical finding rather than a patient complaint 3
Dehydration-Related Complaints
- Patients often report symptoms related to severe dehydration including poor skin turgor 3
- Tachycardia and feelings of weakness result from volume depletion 3
Neurological Symptoms
- Altered mental status ranging from confusion to drowsiness may be present, though severe obtundation or coma is less common 3
- Headache and behavior changes can occur 4
Important Clinical Context
Preceding Illness
- A preceding febrile illness is commonly reported, as infection is the most frequent precipitating factor occurring in 52-69% of cases 5, 1
Timing and Evolution
- DKA symptoms typically develop rapidly over hours rather than days, distinguishing it from hyperosmolar hyperglycemic state 3
- The first symptoms usually come on gradually over hours to days and include drowsiness, flushed face, thirst, and loss of appetite 6
Critical Pitfall to Avoid
Do not dismiss vague constitutional symptoms like weakness and fatigue in diabetic patients, as these may be the predominant presenting complaints before more dramatic symptoms like vomiting develop. The combination of any gastrointestinal symptoms with polyuria/polydipsia in a diabetic patient should prompt immediate evaluation for DKA 1, 2.