What Is Diabetic Ketoacidosis?

Diabetic ketoacidosis, also known as DKA, is a buildup of acids in your blood. It can happen when your
blood sugar is too high for too long. DKA is a serious complication of diabetes and could be life-
threatening, but it usually takes many hours to become that serious. You can treat it and prevent it, too.

Diabetic Ketoacidosis Symptoms

Diabetic ketoacidosis symptoms can appear quickly and may even be your first warning sign that you
have diabetes. Symptoms include:

Dry mouth

Dry skin

Feeling very thirsty

Frequent peeing

Nausea or vomiting

Weakness

Fatigue

Confusion or less alertness

Flushed face

Headache

Muscle aches

Sweet-smelling breath

Belly pain

Shortness of breath

Call your doctor or go to the emergency room right away if you have any of the symptoms below and
your ketones are moderate to high when you test them using a home kit, or if you have more than one
symptom:

You’ve been throwing up for more than 2 hours.

You feel queasy or your belly hurts.

Your breath smells fruity.

You’re tired, confused, or woozy.

You’re having a hard time breathing

Diabetic Ketoacidosis Causes and Risk Factors

Diabetic ketoacidosis usually happens because your body doesn’t have enough insulin. Your cells can’t
use the sugar in your blood for energy, so they use fat for fuel instead. Burning fat makes acids called
ketones. If the process goes on for a while, they could build up in your blood. That excess can change
the chemical balance of your blood and throw off your entire system.

People with type 1 diabetes are at risk for ketoacidosis, since their bodies don’t make any insulin.
Your ketones can also go up when you:

Miss a meal

Are sick or stressed

Have an insulin reaction

Haven’t injected enough insulin

DKA can happen to people with type 2 diabetes, but it’s rare. If you have type 2, especially when you’re
older, you’re more likely to have a condition with some similar symptoms called HHNS (hyperosmolar
hyperglycemic nonketotic syndrome). It can lead to severe dehydration.

Risk factors for DKA include:

Having type 1 diabetes, even if it’s undiagnosed

Missing your insulin dose often

Not taking your insulin as prescribed

Stomach illness

Infections

Heart disease, such as a heart attack

Recent stroke

Blood clot in your lungs

Serious illness or any trauma

Pregnancy

Surgery

Medicines like steroids or antipsychotics

Using illegal drugs, such as cocaine

Diabetic Ketoacidosis Diagnosis and Tests

Test your ketones when your blood sugar is over 250 mg/dL (milligrams per deciliter) or
you have any of the above symptoms of high blood sugar, such as dry mouth, feeling
really thirsty, or peeing a lot.

You can check your sugar levels with a urine test strip. Some glucose meters measure

ketones, too. Try to bring your blood sugar down, and check your ketones again in 30
minutes.

Your doctor can give you a physical exam, ask about your symptoms, and discuss your
medical history. They can order these tests to diagnose DKA too:

 Bloodwork, including metabolic panel and electrolytes

 Urinalysis
 Arterial blood gas
 Blood pressure
 Tests for signs of infection
 Chest X-ray
 Electrocardiogram

Diabetic Ketoacidosis Treatment

If you don't treat ketoacidosis, you could pass out, go into a coma, and possibly die. You
should go to the hospital to treat DKA. There, you will receive emergency treatments like:

 Insulin through an IV to bring your ketones down

 Fluids to get you hydrated and bring your blood chemistry back into balance
 Electrolyte replacement through an IV to replace key minerals like
sodium, potassium, and chloride to keep your heart, muscles, and nerves working
properly
 If you have any infection, antibiotics
 If your doctor suspects you’re at risk for a heart attack, a further heart evaluation
Diabetic Ketoacidosis Complications

DKA complications are possible if you don’t have emergency treatments like electrolyte
replacement and insulin. They include:

 Low blood sugar or hypoglycemia

 Low potassium or hypokalemia
 Brain swelling (cerebral edema) if your blood sugar levels are adjusted too quickly
 Loss of consciousness
 Death

Diabetic Ketoacidosis Prevention

Your doctor may change your insulin dose, or the kind you use, to prevent DKA from
happening again.

Good blood sugar control will help you avoid ketoacidosis in the future. Make sure you
manage your diabetes through your diet, exercise, medications, and self-care.

Follow these steps to help prevent DKA:

 Drink lots of water or sugar-free, nonalcoholic beverages.

 Take your medicines as directed.
 Follow your meal plan closely.
 Keep up with your exercise program.
 Test your blood sugar regularly.
 Check for expired insulin.
 Don't use your insulin dose if it has clumps. Insulin should either be clear or evenly
cloudy with small flecks.
 If you're on an insulin pump, look closely for insulin leaks, and check your tube
connections for air bubbles.
 Talk to your doctor if your blood sugar levels are often out of your target range.
 Manage your insulin dose with help from your doctor or diabetes coach. Make
adjustments based on your blood sugar levels, what you eat, activity levels, or
during any illness.
 Create a DKA emergency plan. If your blood sugar levels are too high or
your urine has too many ketones, make a plan to go to the hospital.

overview
Practice Essentials
Diabetic ketoacidosis (DKA) is an acute, major, life-threatening complication of diabetes characterized
by hyperglycemia, ketoacidosis, and ketonuria. It occurs when absolute or relative insulin deficiency
inhibits the ability of glucose to enter cells for utilization as metabolic fuel, the result being that the liver
rapidly breaks down fat into ketones to employ as a fuel source. The overproduction of ketones ensues,
causing them to accumulate in the blood and urine and turn the blood acidic. DKA occurs mainly in
patients with type 1 diabetes, but it is not uncommon in some patients with type 2 diabetes. Laboratory
studies for DKA include glucose blood tests, serum electrolyte determinations, blood urea nitrogen
(BUN) evaluation, and arterial blood gas (ABG) measurements. Treatment includes correction of fluid
loss with intravenous fluids; correction of hyperglycemia with insulin; correction of electrolyte
disturbances, particularly potassium loss; correction of acid-base balance; and management of concurrent
infection (if present).
Signs and symptoms of diabetic ketoacidosis
The most common early symptoms of DKA are the insidious increase in polydipsia and polyuria. The
following are other signs and symptoms of DKA:
 Malaise, generalized weakness, and fatigability
 Nausea and vomiting; may be associated with diffuse abdominal pain, decreased appetite, and
anorexia
 Rapid weight loss in patients newly diagnosed with type 1 diabetes
 History of failure to comply with insulin therapy or missed insulin injections due to vomiting or
psychological reasons or history of mechanical failure of insulin infusion pump
 Decreased perspiration
 Altered consciousness (eg, mild disorientation, confusion); frank coma is uncommon but may occur
when the condition is neglected or with severe dehydration/acidosis