Symptoms of Diabetic Ketoacidosis (DKA)
DKA typically presents with polyuria, polydipsia, nausea, vomiting, abdominal pain, and dehydration, with symptoms evolving rapidly over less than 24 hours, distinguishing it from hyperosmolar hyperglycemic state which develops over days to weeks. 1
Primary Metabolic and Gastrointestinal Symptoms
Polyuria (excessive urination) and polydipsia (excessive thirst) are the most common presenting symptoms, occurring in approximately 58% of cases, resulting from osmotic diuresis caused by hyperglycemia 1, 2
Nausea and vomiting occur in approximately 52% of patients and can be severe enough to mimic an acute surgical abdomen 1, 2
Abdominal pain is present in approximately 18-25% of cases and can be severe enough to suggest an acute surgical condition, with up to 25% of patients experiencing coffee-ground emesis from hemorrhagic gastritis 1, 3
Polyphagia (excessive hunger) with paradoxical weight loss frequently occurs as the body breaks down fat and muscle for energy in the absence of effective insulin action 3
Respiratory and Cardiovascular Signs
Kussmaul respirations (deep, labored breathing pattern) indicate severe metabolic acidosis and are a hallmark physical finding 1, 3
Tachycardia and hypotension result from volume depletion and dehydration, with hypotension occurring in approximately 9% of cases 1, 2
Heavy breathing and rapid pulse represent more severe manifestations of the metabolic acidosis 4
Neurological Manifestations
Altered mental status ranging from confusion and drowsiness to profound lethargy occurs in approximately 24-61% of cases, though severe obtundation or coma is less common in DKA compared to hyperosmolar hyperglycemic state 1, 2
Drowsy feeling, confusion, and inability to concentrate can progress to disorientation, seizures, unconsciousness, or death if untreated 4
Headache and behavior changes may be present 3
Physical Examination Findings
Dehydration with poor skin turgor is present in approximately 97% of cases 1, 3, 2
Weakness, severe fatigue, and malaise are frequently reported as the body's energy metabolism is severely impaired 3, 5
Fruity odor on the breath (from acetone) develops gradually over hours to days 4
Flushed face and loss of appetite are early symptoms that typically come on gradually 4
Important Clinical Context
Preceding febrile illness or infection is commonly reported, as infection is the most frequent precipitating factor occurring in 52-69% of cases, though only 33% of patients with sepsis actually present with fever 1, 3, 2
Normothermia or even hypothermia may be present despite underlying infection due to peripheral vasodilation, with hypothermia being a poor prognostic sign 1
Temporal Evolution
Rapid symptom onset is characteristic, with the metabolic alterations of DKA typically evolving within 24 hours, though occasionally the entire presentation may develop more acutely with no prior warning symptoms 1, 3
This rapid evolution (hours to days) contrasts sharply with hyperosmolar hyperglycemic state, which develops over days to a week 1
Critical Warning Signs Requiring Immediate Medical Attention
Inability to tolerate oral hydration, blood glucose levels not improving with insulin administration, altered mental status, or any signs of worsening illness mandate immediate emergency department evaluation 1
Severe symptoms including nausea, vomiting, stomach pain, dehydration, loss of consciousness indicate progression to life-threatening DKA requiring immediate medical assistance 4