Diabetic ketoacidosis (patient information)

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 * 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, but 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, urin 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 fluids lost through excessive urination and vomiting. Prognosis of diabetic ketoacidosis varies, depending on patients' age, treatment and complications.

What are the symptoms of Diabetic ketoacidosis?
The following signs and symptoms warn you the possibility 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

 * Severe diabetic hypoglycemia
 * Hyperosmolar nonketotic coma
 * Acute pancreatitis

What causes Diabetic ketoacidosis?
Sugar which is the main source of energy for cells, need Insulin to enter inside the cells. When the patient lack 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 ketones bodies.

This process is triggered in the presence of any infection or illness.

Who is at highest risk?

 * For patients with type 1 diabetes, stresses such as infection, trauma, heart attack,surgery or missing doses of insulin, can lead to diabetic ketoacidosis.
 * People with type 2 diabetes, not usually as type 1, may lead to diabetic ketoacidosis as a complication by a severe illness.

When to seek urgent medical care?
Call your health care provider if symptoms of diabetic 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

 * The patient with medical history of diabetes, during an illness such as pneumonia, heart attack, stroke or pregnancy.*Blood sugar level higher than 240 mg/dl.
 * Higer blood ketone level
 * 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 urin 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 under a nomal scope. 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 diseases.

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-moniting of 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, pranancy or sutgery, 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.