diabetic ketoacidosis

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Related to diabetic ketoacidosis: diabetic diet, diabetic coma

Diabetic Ketoacidosis



Diabetic ketoacidosis is a dangerous complication of diabetes mellitus in which the chemical balance of the body becomes far too acidic.


Diabetic ketoacidosis (DKA) always results from a severe insulin deficiency. Insulin is the hormone secreted by the body to lower the blood sugar levels when they become too high. Diabetes mellitus is the disease resulting from the inability of the body to produce or respond properly to insulin, required by the body to convert glucose to energy. In childhood diabetes, DKA complications represent the leading cause of death, mostly due to the accumulation of abnormally large amounts of fluid in the brain (cerebral edema). DKA combines three major features: hyperglycemia, meaning excessively high blood sugar kevels; hyperketonemia, meaning an overproduction of ketones by the body; and acidosis, meaning that the blood has become too acidic.
Insulin deficiency is responsible for all three conditions: the body glucose goes largely unused since most cells are unable to transport glucose into the cell without the presence of insulin; this condition makes the body use stored fat as an alternative source instead of the unavailable glucose for energy, a process that produces acidic ketones, which build up because they require insulin to be broken down. The presence of excess ketones in the bloodstream in turn causes the blood to become more acidic than the body tissues, which creates a toxic condition.

Causes and symptoms

DKA is most commonly seen in individuals with type I diabetes, under 19 years of age and is usually caused by the interruption of their insulin treatment or by acute infection or trauma. A small number of people with type II diabetes also experience ketoacidosis, but this is rare given the fact that type II diabetics still produce some insulin naturally. When DKA occurs in type II patients, it is usually caused by a decrease in food intake and an increased insulin deficiency due to hyperglycemia.
Some common DKA symptoms include:
  • high blood sugar levels
  • frequent urination (polyuria) and thirst
  • fatigue and lethargy
  • nausea
  • vomiting
  • abdominal pain
  • fruity odor to breath
  • rapid, deep breathing
  • muscle stiffness or aching
  • coma


Diagnosis requires the demonstration of hyperglycemia, hyperketonemia, and acidosis. DKA is established if the patient's urine or blood is strongly positive for glucose and ketones. Normal glucose levels in a non-diabetic person on average range from 80-110 mg/dl. A person with diabetes will typically fluctuate outside those parameters. DKA glucose levels exceed 250 mg/dl and can reach 400 to 800 mg/dL. A low serum bicarbonate level (usually below 15 mEq/L) is also present, indicative of acidosis.
A blood test or urinalysis can quickly determine the concentration of glucose in the bloodstream. Test strips are available to patients commercially can submerge in urine to detect the presence or concentration of ketones.

Key terms

Acidosis — A condition that causes the pH of the blood to drop and become more acidic.
Diabetes mellitus — Disease characterized by the inability of the body to produce or respond properly to insulin, required by the body to convert glucose to energy.
Edema — The presence of abnormally large amounts of fluid in the intercellular tissue spaces of the body.
Glucose — The type of sugar found in the blood.
Hyperglycemia — Condition characterized by excessively high levels of glucose in the blood, and occurs when the body does not have enough insulin or cannot use the insulin it does have to turn glucose into energy. Hyperglycemia is often indicative of diabetes that is out of control.
Hyperketonemia — Condition characterized by an overproduction of ketones by the body.
Hypoglycemia — Lower than normal levels of glucose in the blood.
Hypokalemia — A deficiency of potassium in the blood.
Insulin — A hormone secreted by the pancreas in response to high blood sugar levels that induces hypoglycemia. Insulin regulates the body's use of glucose and the levels of glucose in the blood by acting to open the cells so that they can intake glucose.
Ketones — Poisonous acidic chemicals produced by the body when fat instead of glucose is burned for energy. Breakdown of fat occurs when not enough insulin is present to channel glucose into body cells.
Lactic acidosis — A serious condition caused by the build up of lactic acid in the blood, causing it to become excessively acidic. Lactic acid is a by-product of glucose metabolism.
Metabolism — The sum of all chemical reactions that occur in the body resulting in growth, transformation of foodstuffs into energy, waste elimination, and other bodily functions.
Polyuria — Excessive secretion of urine.
Type I diabetes — Also called juvenile diabetes. Type I diabetes typically begins early in life. Affected individuals have a primary insulin deficiency and must take insulin injections.
Type II diabetes — Type II diabetes is the most common form of diabetes and usually appears in middle aged adults. It is often associated with obesity and may be delayed or controlled with diet and exercise.


Ketoacidosis is treated under medical supervision and usually in a hospital setting.
Basic treatment includes:
  • administering insulin to correct the hyperglycemia and hyperketonemia
  • replacing fluids lost through excessive urination and vomiting intravenously
  • balancing electrolytes to re-establish the chemical equilibrium of the blood and prevent potassium deficiency (hypokalemia) during treatment
  • treatment for any associated bacterial infection


With proper medical attention, DKA is almost always successfully treated. The DKA mortality rate is about 10%. Coma on admission adversely affects the prognosis. The major causes of death are circulatory collapse, hypokalemia, infection, and cerebral edema.


Once diabetes has been diagnosed, prevention measures to avoid DKA include regular monitoring of blood glucose, administration of insulin, and lifestyle maintenance. Glucose monitoring is especially important during periods of stress, infection, and trauma when glucose concentrations typically increase as a response to these situations. Ketone tests should also be performed during these periods or when glucose is elevated.



American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) DIABETES (800-342-2383). http://www.diabetes.org/.
Juvenile Diabetes Foundation. 120 Wall St., 19th Floor, New York, NY 10005. (800) 533-CURE. http://www.jdf.org/.
National Institute of Diabetes and Digestive and Kidney Disorders (NIDDK). 31 Center Drive, MSC 2560, Bethesda, MD 20892-2560. http://www.niddk.nih.gov.
Gale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. All rights reserved.

diabetic ketoacidosis (DKA),

buildup of ketones in blood due to breakdown of stored fats for energy; a complication of diabetes mellitus. Untreated, can lead to coma and death.
Farlex Partner Medical Dictionary © Farlex 2012

diabetic ketoacidosis

The American Heritage® Medical Dictionary Copyright © 2007, 2004 by Houghton Mifflin Company. Published by Houghton Mifflin Company. All rights reserved.

diabetic ketoacidosis

A hyperglycemia-induced clinical crisis most common in type 1 DM Clinical N&V, thirst, diaphoresis, hyperpnea, drowsiness, fever, prostration, coma, possibly death Lab ↑↑↑ Glucose, often > 33.6 mmol/L–US: > 600 mg/dL, ↑ ketone bodies, relative ↑ in protein, albumin, Ca2+, BR, alk phos, AST, CK, anion gap, acidosis, dehydration, ↓ K+, Na+, phosphate Management Insulin, fluid and electrolyte replacement, treat initiating factors–eg, leukocytosis or hypothermia, avoid complications–eg, hypokalemia, late hypoglycemia
McGraw-Hill Concise Dictionary of Modern Medicine. © 2002 by The McGraw-Hill Companies, Inc.

di·a·betic ke·to·a·ci·do·sis

(DKA) (di-ă-bet'ik kē'tō-as'i-dō'sis)
Buildup of ketones in blood due to breakdown of stored fats for energy; a complication of diabetes mellitus. Untreated, can lead to coma and death.
Medical Dictionary for the Health Professions and Nursing © Farlex 2012

di·a·betic ke·to·a·ci·do·sis

(DKA) (di-ă-bet'ik kē'tō-as'i-dō'sis)
Buildup of ketones in blood due to breakdown of stored fats for energy; a complication of diabetes mellitus. Untreated, can lead to coma and death.
Medical Dictionary for the Dental Professions © Farlex 2012
References in periodicals archive ?
Treatment of diabetic ketoacidosis (DKA)/hyperglycemic hyperosmolar state (HHS): Novel advances in the management of hyperglycemic crises (UK versus USA).
Diabetic Ketoacidosis Occurring in Patient on Newly Started Insulin Glargine U300.
Acute pancreatitis secondary to diabetic ketoacidosis induced hypertriglyceridemia in a young adult with undiagnosed type 2 diabetes.
Thrombotic microangiopathic syndrome: a novel complication of diabetic ketoacidosis. Indian Pediatr.
Abbreviations DKA: Diabetic ketoacidosis ICU: Intensive care unit PD-1: Antiprogrammed death 1 receptor PD-1L: Programmed death ligand GADA: Glutamic acid decarboxylase autoantibodies IAA: Insulin autoantibodies IA-2A: Islet antigen 2 autoantibodies ICA: Islet cell antibodies ZnT8A: Zinc transporter 8 autoantibodies.
Wykretowicz, "The DKA that wasn't: a case of euglycemic diabetic ketoacidosis due to empagliflozin," Oxford Medical Case Reports, vol.
Diabetic ketoacidosis is defined by the presence of blood glucose levels greater than 250 mg/dL, being this the main finding, associated with metabolic acidosis (pH < 7.3 and serum bicarbonate < 15 mEq/dL) with an increased anion gap and the presence of ketone bodies in the blood and/or urine [1].
Belanger et al., "Diagnosis and treatment of diabetic ketoacidosis and the hyperglycemic hyperosmolar state," Canadian Medical Association Journal, vol.
The patient was started on an insulin drip for diabetic ketoacidosis. The isoproterenol was discontinued, and a pacemaker was placed.
It is thought that it generally develops secondary to electrolyte imbalance as with the other cardiac complications of diabetic ketoacidosis (3, 4).
Alex Wellington become seriously unwell with diabetic ketoacidosis