Diabetic ketoacidosis (DKA) is a complication of diabetes mellitus. It is characterized by a severe rise in blood sugar or hyperglycemia along with dehydration, shock and in some cases unconsciousness. The condition is brought about by a lack of insulin in the body.

Pathology of DKA

DKA is more common among people with type 1 diabetes or those with type 2 diabetes who take insulin for blood sugar control. Young children with type 1 diabetes are at the greatest risk of diabetic ketoacidosis.

As the blood sugar rises due to a relative lack of insulin, the body fails to upatake this glucose from the blood and instead enegy is provided through the breakdown of fats in the liver. This fat breakdown produces highly acidic compounds called ketones which accumulate in the body and cause the blood to become acidic (ketoacidosis).

Causes

DKA is commonly caused by factors that raise the requirement for insulin in the body. These include:

• Acute infection
• Missed doses of insulin
• Major injury or surgery
• Alcohol or drug abuse

Symptoms

The symptoms of DKA include:

• Excessive thirst
• Passing large volumes of urine
• Abdominal cramps
• Vomiting
• Deep and rapid breathing or hyperventilation
• In severe cases, skin may be cool and clammy and the person may seem dehydrated, have a rapid heart rate, shallow breathing, blurred vision or even loss of consciousness.
• Fruity or pungent smelling breath due to the presence of acetone and ketones in the breath.

Diagnosis and treatment

In the case of DKA, blood has the following features:

• pH of blood is below the usual 7.3
• Blood and urine levels of ketones are high
• Blood osmolarilty is low
• There may be low blood potassium

In cases where DKA is diagnosed early, an insulin injection to correct the relative lack of insulin is usually enough to treat the condition. Individuals with more severe and advanced disease need to be hospitalized as there is a higher risk of life threatening complications such as coma, dehydration and brain damage. These individuals are given a combination of fluids to correct dehydration and insulin to correct hyperglycemia.