Jun 22 2010

Diabetic Ketoacidosis (DKA)

What is Diabetic Ketoacidosis (DKA)?
Diabetic ketoacidosis is defined clinically as an acute state of severe uncontrolled diabetes that requires emergency treatment with insulin and intravenous fluids. Biochemically, diabetic ketoacidosis is defined as an increase in the serum concentration of ketones greater than 5 mEq/L, a blood glucose level of greater than 250 mg/dL, blood pH of less than 7.2, and a bicarbonate level of 18 mEq/L or less.

Diabetic ketoacidosis develops when you have too little insulin in your body. Without sufficient amount of insulin, your body begins to break down fat as an alternative energy source. A process in which your body converts fats into energy is called ketosis. In turn, this process produces toxic acids in the bloodstream called ketones, eventually leading to diabetic ketoacidosis if untreated.

Diabetic ketoacidosis is an acute complication of diabetes. It mainly affects people who have type 1 diabetes. However, it can also happen with other types of diabetes, including type 2 diabetes and gestational diabetes (during pregnancy).

Symptoms of Diabetic Ketoacidosis
Diabetic ketoacidosis is a very dangerous and serious condition. People with diabetes should contact their doctor or get to a hospital immediately if they have the symptoms of Diabetic ketoacidosis. The first symptoms to appear are usually:

  • Excessive thirst
  • Dry mouth
  • Frequent urination
  • Nausea and vomiting
  • Abdominal pain
  • Weakness or fatigue
  • Trouble breathing (short, deep breaths)
  • Decreased appetite
  • A fruity odor on the breath
  • Confusion or trouble concentrating
    Dry or flushed skin

Causes of Diabetic Ketoacidosis
Diabetic Ketoacidosis occurs when a person with diabetes becomes dehydrated. The main cause of Diabetic ketoacidosis is not enough insulin. A lack of insulin causes the glucose can not get into your cells, which need glucose for energy. This causes your body’s glucose levels to rise. To get energy, the body starts to break down fat. This process causes ketones to build up. Ketones can poison the body. High blood glucose levels cause you to urinate often, which leads to a lack of fluids in the body (dehydration).
The most common triggering causes a person with diabetes to develop diabetic ketoacidosis are:

  • infection such as diarrhea, vomiting, and/or high fever (40%),
  • missed or inadequate insulin (25%), and
  • newly diagnosed or previously unknown diabetes (15%).

Various other triggering causes of diabetic ketoacidosis may include:

  • Stress or tension
  • Physical or emotional trauma
  • Heart attack or Stroke
  • Alcohol abuse
  • Drug abuse
  • Surgery

Diagnosis of Diabetic Ketoacidosis
Ketosis (a process in which your body converts fats into energy) increases blood glucose level, blood ketones and dehydration. So ketosis test involves glucose test, ketone test and eletrolyte test.

A physical exam and various blood tests are required to diagnose diabetic ketoacidosis in a suspected patient. In some cases, additional tests may be needed to determine what triggered the  diabetic ketoacidosis or what damage or the ketoacidosis may have caused.

Blood tests

  • Blood tests used in the diagnosis of diabetic ketoacidosis will measure:
  • Blood glucose level. If there is not enough insulin in your body, your blood glucose level will rise (hyperglycemia).
  • Ketone level. A high level of ketones indicates that your body breaks down fat and protein for energy.
  • Blood acidity. If you have excess ketones in your blood, your blood will become acidic (acidosis).
  • Blood Electrolyte test: Potassium, sodium, blood urea, serum. The absence of insulin can lower the level of several electrolytes in your blood

Additional tests for diabetic ketoacidosis

  • urinalysis,
  • chest X-ray,
  • A recording of the activity of the heart (electrocardiogram)

Treatments of Diabetic Ketoacidosis
If you are diagnosed with diabetic ketoacidosis, you may be treated in the emergency room or admitted to the hospital. Treatment usually consists of three main approaches:

  • Fluid replacement. You will receive fluids — either orally or through a vein (intravenously) — until you are rehydrated.
  • Electrolyte replacement. You will receive electrolytes through your veins to help keep your heart, muscles and nerve cells functioning normally.
  • Insulin therapy. Insulin reverses the processes that cause diabetic ketoacidosis. Along with fluids and electrolytes, you will receive insulin therapy — usually through a vein. When your blood glucose level falls below 250 mg/dL (14 mmol/L) and your blood is no longer acidic, you may be able to stop intravenous insulin therapy and resume your normal insulin therapy.

As your body chemistry returns to normal, your doctor will consider what may have triggered the diabetic ketoacidosis. Depending upon the circumstances, you may need additional treatment. For example, if you have undiagnosed diabetes, your doctor will create a diabetes treatment plan.

Complications of Diabetic Ketoacidosis
Diabetic ketoacidosis is treated with fluids, electrolytes, and insulin. Surprisingly, the most common complications of diabetic ketoacidosis are related to this treatment:

  • Low potassium (hypokalemia). The fluids and insulin used to treat diabetic ketoacidosis may cause your potassium level to drop too low. A low potassium level can impair the activities of your heart, muscles and nerves.
  • Swelling in the brain (cerebral edema). Adjusting your blood glucose level too quickly can produce swelling in your brain.
  • Heart attack and death of bowel tissue due to low blood pressure
  • Renal failure

If diabetic ketoacidosis is not treated properly, the risks are much greater. Diabetic ketoacidosis can lead to loss of consciousness. Eventually, diabetic ketoacidosis can be fatal.

Prevention of Diabetic Ketoacidosis
Diabetic ketoacidosis is caused by low or no insulin in the body, thus if you are strict in your diabetes management, you can prevent the diabetic ketoacidosis.

Diabetic ketoacidosis prevention tips:

  • Commitment to your diabetes care. Take sufficient treatments and/or medications.
  • Monitor you blood glucose regularly.
  • If you suspect that you have any of diabetic ketoacidosis symptoms, talk to your doctor immediately.

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