Advanced Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a dangerous condition characterized by a severe rise in blood sugar or hyperglycemia, depleted bodily fluids, shock, and in some cases unconsciousness. Coma and even death may occur if DKA is left untreated or if it becomes more severe due to excessive vomiting.

Symptoms of DKA

• In the early stages of DKA, the affected individual appears flushed and breathes rapidly and deeply. This is called hyperventilation.
• As the condition progresses, the skin may turn pale, cool and clammy, dehydration may begin to set in and the heart rate may become rapid and breathing shallow.
• Nausea, vomiting and severe abdominal cramps.
• Blurred vision
• Fruity or pungent smelling breath due to the presence of acetone and ketones in the breath.

Pathophysiology

Although DKA can occur in patients with type 2 diabetes, it mainly develops in people with type 1 diabetes who need to take insulin for their condition. If individuals do not receive insulin, they will develop DKA.

If there is a shortage of insulin, the body fails to use glucose in the blood for energy and instead fats are broken down in the liver. When these fats are broken down, acidic compounds called ketones are produced as a by-product. These ketones build up in the body and eventually cause ketoacidosis. Aside from missed or inadequate doses of insulin, another common cause of DKA is infection or illness as this can raise the level of hormones that counteract the effects of insulin. In addition, the dehydration caused by major injury or surgery can raise levels of these hormones.

Diagnosis and treatment

Blood tests are performed to check the sugar levels and blood pH, which is classified as acidic if it is below the usual 7.3. Unlike non-ketotic hyperosmolar coma, in DKA the blood and urine levels of ketones are high and the blood osmolarilty is low.

Treatment involves rehydrating the patient with isotonic fluids and replacing lost electrolytes with supplements such as potassium, magnesium and phosphates. Insulin is administered intravenously to reduce blood levels of glucose and reverse ketoacidosis.