DKA; Ketoacidosis; Diabetic coma
Definition Return
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Diabetic ketoacidosis is a complication of diabetes.
It is caused by the buildup of by-products of fat breakdown, called ketones.
This occurs when glucose is not available as a fuel source for the body, and fat
is used instead.
Causes Return
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People with diabetes lack enough insulin, a hormone the body uses to process
glucose (a simple sugar) for energy. When glucose is not available, body fat is
broken down instead. The by-products of fat metabolism
are ketones. When fat is metabolized, ketones build up in the blood and
"spill" over into the urine. A condition called ketoacidosis develops
when the blood becomes more acidic than body tissues.
Blood
glucose levels rises (usually higher than 300 mg/dL) because the liver
produces glucose to try to combat the problem, but the cells cannot take up that
glucose without insulin. Diabetic ketoacidosis may lead to the initial diagnosis
of type 1
diabetes, as it is often the first symptom that causes the person to come to
medical attention. It can also be the result of increased insulin needs in
someone already diagnosed with type 1 diabetes. Infection, trauma, heart attack,
or surgery can lead to diabetic ketoacidosis in such cases.
People with type
2 diabetes usually develop ketoacidosis only under conditions of severe
stress. Not following the prescribed diet and treatment is usually the cause
when episodes are repeated.
Symptoms Return
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Additional symptoms that may be associated with this disease:
Exams and Tests
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This disease may also alter the results of the following tests:
Treatment Return
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The goal of treatment is to correct the elevated blood glucose level by
giving additional insulin, and to replace fluids lost through excessive
urination and vomiting. A person with diabetes may be able to recognize the
early warning signs and make appropriate corrections at home, before the
condition progresses.
If ketoacidosis is severe, hospitalization is required to control the
condition. Insulin replacement will be given, fluid and electrolytes
will be replaced, and the cause of the condition (such as infection) will be
identified and treated.
Outlook (Prognosis)
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Cell damage from acidosis
can lead to severe illness or death. Improved therapy for young people with
diabetes has decreased the death rate associated with this condition. However,
it remains a significant risk in the elderly, and in people who fall into a
profound coma when treatment has been delayed.
Possible Complications
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When to Contact a Medical Professional
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This condition can become a medical emergency. Call your health care provider
if you notice early symptoms of diabetic ketoacidosis.
Go to the emergency room or call the local emergency number (such as 911) if
nausea, vomiting, fruity breath, mental stupor, difficulty breathing, or
decreased consciousness occur.
Prevention Return
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Diabetics should learn to recognize the early warning signs and symptoms of
ketoacidosis. Measurement of urine ketones in people with infections or people
on insulin pump therapy can give more information than glucose measurements
alone. Insulin pump users need to frequently check to see that insulin is still
flowing through the tubing, and that no blockages, kinks, or disconnections have
occurred.