How to explain dka to a patient?
The most common early symptoms of DKA are the insidious increase in polydipsia and polyuria. The following are other signs and symptoms of DKA:
Signs and symptoms of DKA associated with possible intercurrent infection are as follows:
See Clinical Presentation for more detail.
On examination, general findings of DKA may include the following:
In addition, evaluate patients for signs of possible intercurrent illnesses such as MI, UTI, pneumonia, and perinephric abscess. Search for signs of infection is mandatory in all cases.
Initial and repeat laboratory studies for patients with DKA include the following:
Note that high serum glucose levels may lead to dilutional hyponatremia; high triglyceride levels may lead to factitious low glucose levels; and high levels of ketone bodies may lead to factitious elevation of creatinine levels.
Radiologic studies that may be helpful in patients with DKA include the following:
Do not delay administration of hypertonic saline or mannitol in those pediatric cases where cerebral edema is suspected, as many changes may be seen late on head imaging.
See Workup for more detail.
Treatment of ketoacidosis should aim for the following:
Regular and analog human insulins are used for correction of hyperglycemia, unless bovine or pork insulin is the only available insulin.
Medications used in the management of DKA include the following:
See Treatment and Medication for more detail.
Diabetes-related ketoacidosis (DKA) is a serious and life-threatening, but treatable, complication that affects people with diabetes and those who have undiagnosed diabetes.
Diabetes-related ketoacidosis occurs when your body doesn't have enough insulin (a hormone that's either produced by your pancreas or injected). Your body needs insulin to turn glucose, your body’s go-to source of fuel, into energy. If there’s no insulin or not enough insulin, your body starts breaking down fat for energy instead. As fat is broken down, ketones are released into the bloodstream.
For a person with diabetes, a high amount of ketones causes their blood to become acidic (the blood pH is too low). This creates an emergency medical situation that requires immediate attention and treatment.
Diabetes-related ketoacidosis can develop in people of any age who have diabetes or undiagnosed diabetes.
Hyperglycemia (high blood sugar) and diabetes-related ketoacidosis both happen when your body doesn't have enough insulin or isn't using the insulin it has properly.
The difference is that DKA is an acute complication, meaning it has a severe and sudden onset. While very high blood sugar (above 250 mg/dL) is almost always a contributing factor to DKA, other conditions need to be present to have DKA, including ketones in your blood and/or urine. You can have high blood sugar without having ketones in your blood and/or urine.
Untreated high blood sugar can lead to DKA. This is why it’s important to treat high blood sugar with insulin as soon as possible.
Although it’s not as common, you can be in DKA even if your blood sugar is lower than 250 mg/dL. This is known as euglycemic diabetes-related ketoacidosis (euDKA).
Even though they sound alike, diabetes-related ketoacidosis and ketosis are two different things.
Ketosis occurs when you have ketones in your blood and/or urine but not enough to turn your blood acidic. It usually happens if you are eating a low-carbohydrate diet, if you’re fasting or if you’ve drunk too much alcohol. Ketosis isn't harmful.
Symptoms of DKA can appear quickly.
Early symptoms of DKA can include:
As DKA progresses, more symptoms may appear:
DKA is a medical emergency. Call your local emergency services immediately if you think you may be experiencing DKA.
If left untreated, DKA can lead to a coma or death. If you use insulin, make sure you discuss the risk of DKA with your healthcare team and have a plan in place.
If you have type 1 diabetes and have a blood sugar reading of over 240 milligrams per deciliter (mg/dL), you should test yourself for ketones using a urine or blood test.
You should also test if you are sick or planning on exercising and your blood sugar is 240 mg/dL or higher.
Call your doctor if moderate or high levels of ketones are present. Always seek medical help if you suspect you are progressing to DKA.
People with type 2 diabetes are usually at lower risk of DKA. But the risk can increase when your body is under strain due to injury, infection, or surgery.
DKA develops when your body doesn't have enough insulin to allow blood sugar into your cells for use as energy. Instead, your liver breaks down fat for fuel, a process that produces acids called ketones. When too many ketones are produced too fast, they can build up to dangerous levels in your body.