Diabetic Ketoacidosis: Information on Causes, Diagnosis & Treatments

Diabetic ketoacidosis (DKA) is a potentially life-threatening diabetes complication caused by the buildup of acids in the bloodstream when cells are unable to retrieve glucose (sugar) required for energy. DKA is often the result of the body not producing sufficient levels of insulin that allows sugar to transfer into the cells. Instead, the glucose builds up in the bloodstream producing dangerous levels of acid.

The Cause of DKA

Typically, diabetic ketoacidosis is caused when the body does not produce enough insulin and the body is unable to transfer glucose energy from the bloodstream into cells. Instead, the body burns fat for fuel. However, this process causes ketones (acids made by burning fat) to build up in the bloodstream. The high levels of acid can significantly change the chemical balance of the bloodstream and disrupt normal body functioning.

Infections can also result in the development of diabetic ketoacidosis because the infectious bacteria can cause the body to produce excessive levels of cortisol, adrenaline and other hormones that affect the production of insulin. These include urinary tract infections and pneumonia.

• Who Gets Diabetic Ketoacidosis (DKA)?
• The Warning Signs and Symptoms of DKA
• Diagnosing Diabetic Ketoacidosis
• Diabetic Ketoacidosis Treatments
• Preventing DKA

Who Gets Diabetic Ketoacidosis?

Typically, individuals suffering from Type I diabetes have the highest potential risk of developing ketoacidosis. This is because the condition causes the body to make insulin. Instead, the development of ketones can occur when the individual misses a meal, become stressed or sick and or has experiences of insulin reaction. Any problem associated with insulin therapy can trigger diabetic ketoacidosis as can other events including a heart attack, emotional or physical trauma, drug use, alcohol abuse, and taking certain drugs including diuretics and corticosteroids.

Additionally, individual suffering from Type II diabetes mellitus can also develop diabetic ketoacidosis, however, the condition is rare. Uusally, individuals will develop symptoms including severe dehydration that are similar to DKA called hyperosmolar hypoglycemic nonketotic syndrome (HHNS).

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The Warning Signs and Symptoms of DKA

Blood sugar levels over 240 milligrams per deciliter can be a warning sign of the development of diabetic ketoacidosis as can symptoms including dry mouth, high blood sugar, excessive urination, and excessive thirst. Any individual worried about the development of DKA can test their blood sugar levels using a urine test strip. Ketones can also be measured using some glucometers. At this sugar level, it is essential to lower this level and keep checking the level of ketones every half hour.

If you are suffering from any of the symptoms listed below or your ketone levels are abnormal it is essential to seek immediate emergency help. These warning signs include:

• Fruity-smelling breath


• Bellyaches


• Blurry vision


• Loss of appetite


• Lack of interest in performing typical activities


• Queasy sensation


• Difficulty waking up


• Feeling woozy, confused or tired


• Excessive vomiting lasting two hours or more


• Difficulty in breathing or rapid breathing


• Dry, hot, flushed skin


• Confusion

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Diagnosing Diabetic Ketoacidosis

Many individuals suffering from diabetes will die from DKA (diabetic ketoacidosis) that causes decreased glucose use, reduced insulin levels, and rising gluconeogenesis levels. Fortunately, diagnosing diabetic ketoacidosis (DKA) is typically a simple procedure that usually requires a doctor to perform plasma glucose concentration tests to determine if the concentration level has reached 250 milligrams per deciliter or higher with a pH level measured below 7.30. Additionally, a positive test for DKA will show bicarbonate levels of 18 mEq per liter or less.

The most common diabetic ketoacidosis tests include:

• Blood sugar levels


• Ketone levels


• Blood acidity


• Blood electrolyte tests


• Chest x-ray


• Urinalysis


• Electrocardiogram (electrical heart activity recording)

As a part of the diagnosis, the doctor will look for obvious indicators and warning signs associated with the condition that includes:

• Decreased reflexes


• Dry mucous membrane


• Difficulty in breathing


• Dry skin


• Ill appearance


• Hypotension (abnormally low blood pressure)


• Tachycardia (abnormally fast heart rate)


• Tachypnea (abnormally fast breathing)


• Diminished skin turgor (tissue rigidity)


• Hypothermia (abnormally low body temperature)


• Fruity ketotic breath odor

The doctor may perform various imaging tests that include head CT scanning, chest radiography, and head MRI (magnetic resonance imaging).

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Treating Diabetic Ketoacidosis

If the doctor has diagnosed you with diabetic ketoacidosis, you will likely admit you to the facility or receiving treatment in an emergency room. The doctor will perform numerous procedures to minimize the symptoms of diabetic ketoacidosis and restore the body to more normal functioning. These treatments typically involve:

• Fluid Replacement – The treating doctor will ensure the patient is receiving adequate fluids either intravenously (through a vein) or orally (by mouth) until they are completely rehydrated. The fluids are essential to replace all fluids that were lost because of excessive urination. The additional fluids also help dilute the excessive built-up levels of bloodstream sugars.


• Electrolyte Replacement – Appropriate levels of chloride, potassium, and sodium in the bloodstream are essential mineral electrolytes needed to produce energy through an electrical charge. When the body lacks efficient levels of insulin, the electrolyte levels can also diminish in the bloodstream. Receiving adequate electrolytes can help maintain the muscles, heart, and nerve cells to ensure they function properly.


• Insulin Therapy – Sufficient levels of insulin in the body can reverse many of the processes that cause the development of diabetic ketoacidosis. In addition to providing electrolytes and fluids to the patient, the doctor will also recommend insulin therapy through an IV. This is especially important when the body's blood sugar levels remain at 240 milligrams per deciliter or higher. Once these levels drop, the blood loses its high acidity and the body restores normal functioning.

When the body's chemistry levels return to a more normal status, the patient will likely undergo additional testing to help isolate potential triggers for the development of DKA. Depending on the results of the testing, the doctor may recommend additional treatment options. The doctor is likely looking for a bacterial infection or determine if the patient suffered a heart attack.

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Preventing Diabetic Ketoacidosis

While the doctor can take immediate steps to alter a person's blood sugar levels and acid levels that cause diabetic ketoacidosis, the patient can do much more to prevent the condition from returning. Typical prevention methods for avoiding the development of diabetic ketoacidosis include:

• Develop and Follow an Effective Diabetes Management Plan – Making healthy diet choices and participating in routine physical activities can significantly improve blood sugar levels and avoid the development of diabetic ketoacidosis. This includes taking oral diabetic medications or insulin on doctor's orders.


• Monitor Blood Sugar Levels – It is crucial to routinely check blood sugar levels and record the information at least three times every day and more often when stressed or feeling anxious. Careful monitoring of blood sugar levels is the most efficient way to remain in the target range and minimize bloodstream complications.


• Adjust Insulin Dosages and Check Ketone Levels When Required – The doctor will likely adjust the level of insulin dosage the patient receives based on typical blood sugar levels. Other factors the doctor will use to determine the accurate insulin dosage will involve what the patient consumes, their level of daily activity, whether they are sick and other associated factors.

If you are experiencing any of the warning signs associated with diabetic ketoacidosis, it is crucial to seek out immediate medical help.

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Sources:

http://www.medscape.com/viewarticle/844754

https://www.cdc.gov/diabetes/statistics/hospitalization_national.htm

https://www.cdc.gov/mmwr/preview/mmwrhtml/00017935.htm