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Ketoacidosis

(Diabetic Coma; Diabetic Ketoacidosis; DKA)

Definition

Ketoacidosis occurs when a person’s blood sugar (glucose) is too high because there is not enough insulin. Instead, the body starts to burn fat for energy. Fat is broken down into acids causing acid levels to build up in the blood. These acids appear in urine and blood as ketones. Ketoacidosis is a serious condition that can lead to coma or death if not treated.
This condition is most commonly found in people with type 1 diabetes and sometimes in people with type 2 diabetes .

Causes

Ketoacidosis is caused by:
  • Not having enough insulin in the body
  • Starvation

Risk Factors

These factors increase your chances of developing ketoacidosis. Tell your doctor if you have any of these risk factors:
  • Diabetes mellitus (type 1 and 2)
  • New infection that may not be obvious (eg, pneumonia , urinary tract infection , sepsis )
  • Not taking insulin as prescribed (eg, skipping doses) or not taking enough insulin
  • New cardiovascular disease (eg, heart attack )
  • New stroke
  • Hemochromatosis —a condition in which the body builds up too much iron
  • Hyperthyroidism —when the thyroid gland becomes overactive and produces too much thyroid hormone
  • Pancreatitis —when the pancreas becomes inflamed
  • Pregnancy
  • Some medicines (eg, antipsychotics)
  • Recreational drug use (eg, cocaine )

Symptoms

If you have any of these symptoms, do not assume it is due to ketoacidosis. These symptoms may be caused by other conditions. But if they are sudden or new, call your doctor.
  • High blood glucose levels (greater than 250 mg per dL)
  • Dry mouth and skin
  • Thirst
  • Urinating often
  • High ketone levels in urine
The following symptoms are very serious and require prompt medical attention by either calling 911 or having someone take you to the nearest emergency room:
  • Drowsiness
  • Vomiting and nausea
  • Severe stomach pain
  • Trouble breathing
  • Fruity breath odor
  • Rapid pulse

Diagnosis

Your doctor will ask about your symptoms and medical history and perform a physical exam.
Tests may include the following:
  • Blood test—to test for levels of glucose and acids in your blood as well as pH
  • Urinalysis—your urine will be tested for ketones and infection
  • Bacterial cultures—to test for infection in your blood
  • Chest x-ray —to examine for pneumonia or cardiopulmonary disease

Treatment

The most important treatment is insulin and fluids. Insulin, fluids, and electrolytes may be given via an IV placed in your arm or hand. Insulin may also be given as an injection under your skin.
IV Being Placed in Hand
IV insertion
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Prevention

To help reduce your chances of getting ketoacidosis, take the following steps:
  • Take your diabetic medicines as recommended by your doctor.
  • Discuss with your doctor the level of ketones that are dangerous for you.
  • Monitor your ketone and blood sugar levels carefully.
  • If you use insulin, stock up on:
    • Short-acting insulin
    • Long-acting insulin
    • Needles and syringes
    • If you use an insulin pump, make sure you have extra infusion and connector sets as well as insulin syringes in case the pump does not work. The most common cause of hyperglycemia for a pump user is a problem with the tubing. This causes problems with insulin delivery.
  • See your doctor if you have infection, cough, sore throat, or pain when you urinate.
  • If you are sick or your blood sugar levels are greater than 250 mg per dL:
    • Check your blood sugar every 3-4 hours.
    • Test your urine for ketones every 4 hours.
  • If you are unable to eat, reduce your insulin dose. Talk with your doctor about the right dose.
  • Take extra insulin if your blood sugar is high. Talk with your doctor about the right dose.
  • Drink plenty of fluids (sugar-free and caffeine-free).
  • If your blood sugar is greater than 250 mg per dL, eat foods that are low in carbohydrates.

RESOURCES

American Diabetes Association http://www.diabetes.org/

National Diabetes Information Clearinghouse http://diabetes.niddk.nih.gov/

CANADIAN RESOURCES

Canadian Diabetes Association http://www.diabetes.ca/

Team Diabetes Canada Canadian Diabetes Association www.diabetes.ca/get-involved/supporting-us/team-diabetes

References

Charfen MA. Diabetic ketoacidosis. Emerg Med Clin North Am . 2005. 23(3):609-628.

Diabetic ketoacidosis (DKA). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated May 25, 2010. Accessed May 25, 2010.

Trachtenbarg DE. Diabetic ketoacidosis: What it is and how to prevent it. Am Fam Physician . 2005 May1;71(9):1721-1722.

Wood D. Type 1 diabetes. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated March 12, 2010. Accessed May 25, 2010.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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