Diabetic ketoacidosis (patient information)
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Jinhui Wu, M.D.; Assistant Editor-In-Chief:Laura Linnemeier
Overview
Diabetic ketoacidosis is a serious complication of diabetes. It may occur in both type 1 diabetes and type 2 diabetes, but is most common in people with type 1 diabetes. Some triggers, such as infection, trauma, heart attack, surgery or missing doses of insulin may lead to this condition. Usual signs and symptoms of diabetic ketoacidosis include shortness of breath, fruity breath, nausea and vomiting, excessive thirst, even confusion, stupor that may progress to coma. Tests of blood sugar level, urine ketone level and arterial blood gas may be helpful for the diagnosis. The goal of treatment of diabetic ketoacidosis is to correct the high glucose level by giving more insulin and to replace fluid loss through excessive urination and vomiting. Prognosis of diabetic ketoacidosis varies, depending on patient's age, treatment and complications.
What are the symptoms of Diabetic ketoacidosis?
The following signs and symptoms are indicative of diabetic ketoacidosis:
- Shortness of breath
- Fruity breath
- Nausea and vomiting
- Excessive thirst
- Dry skin and mouth
- Flushed face
- Frequent urination
- Stomach pain
- Fatigue
- Loss of appetite
- Weakness or fatigue
- Confusion, stupor that may progress to coma
Diseases with similar symptoms
What causes Diabetic ketoacidosis?
Sugar which is the main source of energy for cells, needs insulin to enter inside the cells. When the patient lacks enough insulin, sugar will not be able to enter inside the cell. This situation prompts the release of certain hormones that break down fat. The breakdown of fat produces ketone bodies. This process may be triggered in the presence of any infection, illness or drugs.
Who is at highest risk?
- For patients with type 1 diabetes, stresses such as infection, trauma, heart attack,surgery or missing insulin doses can lead to diabetic ketoacidosis.
- Patients with type 2 diabetes who suffer a severe illness are at risk for diabetic ketoacidosis.
When to seek urgent medical care?
Call your health care provider if symptoms of diabetic ketoacidosis develop. If you experience either of the following symptoms, seeking urgent medical care as soon as possible:
- Vomiting or nausea
- Shortness of breath or fruity breath
- Decreased consciousness or mental stupor
Diagnosis
- Patients with a medical history of diabetes, during an illness such as pneumonia, heart attack, stroke or pregnancy. Blood sugar level higher than 250 mg/dl.
- High blood ketone levels.
- Arterial blood gas: When diabetic ketoacidosis occurs, the blood will become acidic (acidosis). This can damage organs throughout the body.
- Urinalysis：Sugar and ketone can be checked in the urine of patients with diabetic ketoacidosis. Additional tests such as a chest x-ray or a electrocardiogram may be needed to help the doctor determine what triggered the episode of diabetic ketoacidosis or what damage the ketoacidosis may have caused.
Treatment options
The goal of treatment of diabetic ketoacidosis is to correct the high blood glucose level by giving more insulin and to replace fluids lost through excessive urination and vomiting.
- Fluid and electrolyte replacement: The patients will receive fluids and electrolytes to replace those that they lost through excessive urination and vomiting. This can help dilute the excess sugar and help keep a normal internal environment to make the body work well.
- Insulin therapy: The purpose of insulin therapy is to control blood sugar levels. Usually, the patients with diabetic ketoacidosis will receive insulin therapy through a vein.
- Treatment for the trigger of diabetic ketoacidosis: When the patient returns to normal, the doctor will consider what may have triggered the episode of diabetic ketoacidosis and make treatment protocol for the disease.
Medications to avoid
Patients diagnosed with diabetic ketoacidosis should avoid using the following medications:
- Glipizide
- Glyburide
- Glyburide and Metformin
- Linagliptin and Metformin hydrochloride
- Repaglinide
- Saxagliptin hydrochloride and Metformin hydrochloride
If you have been diagnosed with diabetic ketoacidosis, consult your physician before starting or stopping any of these medications.
Where to find medical care for Diabetic ketoacidosis?
Directions to Hospitals Treating diabetic ketoacidosis
What to expect (Outook/Prognosis)?
Prognosis of diabetic ketoacidosis depends on:
- Whether the patient is diagnised or treated in time
- The age of the patient: Older people have worse outcomes than the young.
- Whether complications, such as heart attack, renal failure and hypokalemia occur.
Possible complication
Diabetic Ketoacidosis is a fatal condition if not treated promptly.
Prevention
- Making a healthy lifestyle: Make healthy eating and physical activity part of your daily routine. Take oral diabetes medications or insulin under your doctor's direction.
- Learning to self-monitor your blood sugar level: You may need to learn to check and record your blood sugar level at least several times a day. Careful monitoring is the only way to make sure that your blood sugar level remains within your target range.
- Warning signs and symptoms of ketoacidosis: When people in the conditions of stress such as infections, stroke, pregnancy or surgery, measuring urine ketones may give more information than glucose measurements alone. If you suspect that you have diabetic ketoacidosis, seek emergency care as soon as possible.
Sources
http://www.nlm.nih.gov/medlineplus/ency/article/000320.htm Template:WH Template:WS