Diabetic ketoacidosis history and symptoms
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
History
Age of onset
- Young children (age less than equal to 2 years) tend to present more likely with DKA as the first presentation of type 1 diabetes than older children.[1][2]
- Peripubertal and adolescent girls are affected more than other age groups.
Family History
- Families harboring HLA-associated high-risk genotypes are associated with a high chance of presenting DKA at diabetes onset.[3]
- Patients who have a family history of type 1 diabetes have less chance of developing DKA, possibly due to increased awareness of the disorder.[4]
Initial Presentation
- Patients may present with a history of poor compliance with insulin therapy or missed insulin injections due to vomiting or psychological reasons.
Past Medical History
- DKA is associated with a past medical history of type 1 diabetes.[5]
- Type 2 diabetics may rarely develop DKA at a late stage of the disease due to failure of beta pancreatic cells.[6]
- History of infections (for example, urinary tract infections, pneumonia in an individual suffering from type 1 diabetes.[7]
Social History
- Patients may have a history of use of illicit drugs, for example, alcohol and cocaine.[8]
- Patients may have poor socioeconomic status, which contributes to poor medication adherence in diabetics.[9]
Symptoms
Early Symptoms
The following are the early symptoms of DKA:[10][11]
- Sluggish, extreme tiredness
- Fruity smell to breath/compare to nail polish remover
- Extreme thirst, despite large fluid intake
- Constant urination
- Extreme weight-loss
- Oral Thrush may be present, or/ yeast infections that fail to go away, this is because the normal fungal/flora present in oral cavity/cervix in women, the balance is upset and bacterial began to feast on the high sugar from urine output/ dry mouth from extreme thirst.
- Muscle wasting
- Agitation / Irritation / Aggression / Confusion
Late Symptoms
At this point, DKA is life-threatening and medical attention should be sought immediately. The following are late symptoms of DKA:[12][13][14]
- Emesis (vomiting), although this is not always a sign of late-stage ketoacidosis, and can occur both in early-stage ketoacidosis and in non-ketoacidic hyperglycaemia.
- Confusion
- Abdominal pain
- Loss of appetite
- Flu-like symptoms
- Lethargy and apathy
- Extreme weakness
- Kussmaul breathing ("air hunger"). Patients breathe more deeply and/or rapidly.
- Unconsciousness (diabetic coma) after prolonged DKA. At this stage, speedy medical attention is imperative.
References
- ↑ de Vries L, Oren L, Lazar L, Lebenthal Y, Shalitin S, Phillip M (2013). "Factors associated with diabetic ketoacidosis at onset of Type 1 diabetes in children and adolescents". Diabet. Med. 30 (11): 1360–6. doi:10.1111/dme.12252. PMID 23758313.
- ↑ "Ketoacidosis at first presentation of type 1 diabetes mellitus among children: a study from Kuwait | Scientific Reports".
- ↑ Marigliano M, Morandi A, Maschio M, Costantini S, Contreas G, D'Annunzio G, Calcaterra V, Maffeis C (2013). "Diabetic ketoacidosis at diagnosis: role of family history and class II HLA genotypes". Eur. J. Endocrinol. 168 (1): 107–11. doi:10.1530/EJE-12-0541. PMID 23065995.
- ↑ Hekkala A, Ilonen J, Knip M, Veijola R (2011). "Family history of diabetes and distribution of class II HLA genotypes in children with newly diagnosed type 1 diabetes: effect on diabetic ketoacidosis". Eur. J. Endocrinol. 165 (5): 813–7. doi:10.1530/EJE-11-0376. PMID 21890652.
- ↑ Newton CA, Raskin P (2004). "Diabetic ketoacidosis in type 1 and type 2 diabetes mellitus: clinical and biochemical differences". Arch. Intern. Med. 164 (17): 1925–31. doi:10.1001/archinte.164.17.1925. PMID 15451769.
- ↑ Lin MV, Bishop G, Benito-Herrero M (2010). "Diabetic ketoacidosis in type 2 diabetics: a novel presentation of pancreatic adenocarcinoma". J Gen Intern Med. 25 (4): 369–73. doi:10.1007/s11606-009-1237-9. PMC 2842543. PMID 20119682.
- ↑ Casqueiro J, Casqueiro J, Alves C (2012). "Infections in patients with diabetes mellitus: A review of pathogenesis". Indian J Endocrinol Metab. 16 Suppl 1: S27–36. doi:10.4103/2230-8210.94253. PMC 3354930. PMID 22701840.
- ↑ Warner EA, Greene GS, Buchsbaum MS, Cooper DS, Robinson BE (1998). "Diabetic ketoacidosis associated with cocaine use". Arch. Intern. Med. 158 (16): 1799–802. PMID 9738609.
- ↑ Lewis KR, Clark C, Velarde MC (2014). "Socioeconomic factors associated with pediatric diabetic ketoacidosis admissions in Southern West Virginia". Clin. Endocrinol. (Oxf). 81 (2): 218–21. doi:10.1111/cen.12350. PMID 24117508.
- ↑ Westerberg DP (2013). "Diabetic ketoacidosis: evaluation and treatment". Am Fam Physician. 87 (5): 337–46. PMID 23547550.
- ↑ Roche EF, Menon A, Gill D, Hoey H (2005). "Clinical presentation of type 1 diabetes". Pediatr Diabetes. 6 (2): 75–8. doi:10.1111/j.1399-543X.2005.00110.x. PMID 15963033.
- ↑ Seth P, Kaur H, Kaur M (2015). "Clinical Profile of Diabetic Ketoacidosis: A Prospective Study in a Tertiary Care Hospital". J Clin Diagn Res. 9 (6): OC01–4. doi:10.7860/JCDR/2015/8586.5995. PMC 4525534. PMID 26266145.
- ↑ Barrett EJ, Sherwin RS (1983). "Gastrointestinal manifestations of diabetic ketoacidosis". Yale J Biol Med. 56 (3): 175–8. PMC 2589676. PMID 6419481.
- ↑ Kearney T, Dang C (2007). "Diabetic and endocrine emergencies". Postgrad Med J. 83 (976): 79–86. doi:10.1136/pgmj.2006.049445. PMC 2805944. PMID 17308209.