From the Guidelines
The clinical appearance of diabetic ketoacidosis (DKA) is characterized by hyperglycemia, metabolic acidosis, and ketosis, presenting with symptoms such as polyuria, polydipsia, weight loss, and abdominal pain [ 1 ]. Patients may exhibit Kussmaul breathing, a deep and labored breathing pattern, and may have a fruity odor on their breath due to acetone production.
Key Clinical Features
- Dehydration
- Altered mental status
- Hypotension
- Kussmaul respirations
- Abdominal pain
Laboratory Findings
- Elevated blood glucose levels
- Anion gap metabolic acidosis
- Elevated ketone bodies, such as beta-hydroxybutyrate [ 1 ]. Physical examination may reveal dehydration, altered mental status, and hypotension. The diagnosis of DKA is typically made based on the presence of hyperglycemia, metabolic acidosis, and ketosis [ 1 ]. The clinical presentation of DKA can vary, but it often includes a history of polyuria, polydipsia, polyphagia, weight loss, vomiting, abdominal pain, dehydration, weakness, clouding of sensoria, and finally coma [ 1 ].
From the Research
Clinical Appearance of Diabetic Ketoacidosis (DKA)
The clinical appearance of DKA can vary, but it is typically characterized by:
- Hyperglycemia, although euglycemic DKA can also occur 2, 3
- Metabolic acidosis, with an anion gap and decreased serum bicarbonate levels 4, 3
- Ketonuria or ketonemia, with elevated beta-hydroxybutyrate levels 2, 5, 3
- Symptoms such as polyuria, polydipsia, nausea, vomiting, abdominal pain, weight loss, severe fatigue, dyspnea, and preceding febrile illness 4, 5, 3
- Dehydration, with increased heart and respiratory rates 5
- Electrolyte imbalances, including decreased phosphate and potassium levels 3
Special Considerations
- DKA can be masked by euglycemia and primary metabolic alkalosis, making diagnosis more challenging 2
- Newly diagnosed Type 1 DM patients with DKA may have more severe clinical and biochemical profiles compared to known cases 5
- The use of sodium-glucose cotransporter-2 inhibitors can increase the risk of DKA and euglycemic DKA 3
- Patients with DKA can present with a range of symptoms, from mild to severe, and may require close monitoring and aggressive treatment in an intensive care unit or general medical/surgical ward 6