Diabetic ketoacidosis
Diabetic ketoacidosis (DKA) is a serious and potentially life-threatening complication of diabetes, most commonly seen in individuals with type 1 diabetes but it can also occur in some cases of type 2 diabetes. DKA is characterized by a combination of high blood sugar levels (hyperglycemia), the presence of ketones in the blood and urine, and metabolic acidosis.
The main causes of DKA are a deficiency of insulin in the body, leading to an inability of cells to use glucose for energy. This causes the body to break down fat for energy, resulting in the release of ketones into the bloodstream. Ketones are acidic chemicals that can build up and cause the blood to become more acidic, leading to the symptoms of DKA.
Symptoms of diabetic ketoacidosis can include:
- High blood sugar levels (hyperglycemia)
- Excessive thirst and urination
- Nausea and vomiting
- Abdominal pain
- Rapid breathing (Kussmaul breathing)
- Fruity-smelling breath (due to the presence of acetone in breath)
- Confusion or altered mental status
- Fatigue and weakness
Diagnosis of DKA involves a combination of clinical evaluation, blood tests, and urine tests. Common diagnostic criteria include:
- Blood glucose level typically higher than 250 mg/dL (13.9 mmol/L)
- Blood pH less than 7.3
- Presence of ketones in the blood and urine
- Elevated levels of blood ketone bodies
- Elevated anion gap (indicating metabolic acidosis)
Treatment of DKA involves a combination of insulin therapy, fluids, and electrolyte replacement. The goals of treatment are to normalize blood sugar levels, correct acidosis, and replenish lost fluids and electrolytes. Here’s how DKA is typically treated:
- Insulin therapy: Insulin is administered either through continuous intravenous infusion or frequent subcutaneous injections to lower blood sugar levels and stop the ketone production. The rate of insulin administration may be adjusted based on frequent blood glucose monitoring.
- Fluid replacement: Intravenous fluids are given to correct dehydration and electrolyte imbalances. Typically, isotonic saline is used initially, and the type and rate of fluids are adjusted based on the patient’s needs and laboratory results.
- Electrolyte replacement: Electrolyte imbalances, especially low potassium levels, are common in DKA. Potassium levels are carefully monitored and supplemented as needed to avoid dangerous complications like cardiac arrhythmias.
- Monitoring: Patients in DKA are closely monitored for blood glucose levels, electrolytes, kidney function, and other vital signs. The goal is to gradually correct metabolic abnormalities while preventing rapid shifts that could lead to further complications.
- Treat underlying cause: Identifying and addressing the underlying cause of DKA, such as infections or missed insulin doses, is important to prevent recurrence.
Diabetic ketoacidosis is a medical emergency, and immediate treatment is pertinent to prevent severe complications such as cerebral edema, organ failure, and even death. If you suspect you or someone else is experiencing DKA, seek immediate medical attention.
