Diabetic ketoacidosis history and symptoms

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]


A positive history of type 1 diabetes mellitus, infection and history of poor compliance to insulin regimens are suggestive of diabetic ketoacidosis (DKA). The most common symptoms of DKA include extreme tiredness, vomiting, abdominal pain, fruity smell of breath, weight loss and polyuria.


Age of onset

  • Young children (age less than or equal to 2 years) tend to present more likely with DKA as the first presentation of type 1 diabetes than older children.[1][2]
  • Peripubertal and adolescent girls are affected more than other age groups.

Family history

  • Families harboring HLA-associated high-risk genotypes are associated with a high chance of presenting DKA at diabetes onset.[3]
  • Patients who have a family history of type 1 diabetes have less chance of developing DKA, possibly due to increased awareness of the disorder.[4]

Initial presentation

Past medical history

Social history

  • Patients may have a history of use of illicit drugs, for example, alcohol and cocaine.[8]
  • Patients may have poor socioeconomic status, which contributes to poor medication adherence in diabetics.[9]


Early Symptoms

The following are the early symptoms of DKA:[10][11]

Late Symptoms

At this point, DKA is life-threatening and medical attention should be sought immediately. The following are late symptoms of DKA:[12][13][14]


  1. de Vries L, Oren L, Lazar L, Lebenthal Y, Shalitin S, Phillip M (2013). "Factors associated with diabetic ketoacidosis at onset of Type 1 diabetes in children and adolescents". Diabet. Med. 30 (11): 1360–6. doi:10.1111/dme.12252. PMID 23758313.
  2. "Ketoacidosis at first presentation of type 1 diabetes mellitus among children: a study from Kuwait | Scientific Reports".
  3. Marigliano M, Morandi A, Maschio M, Costantini S, Contreas G, D'Annunzio G, Calcaterra V, Maffeis C (2013). "Diabetic ketoacidosis at diagnosis: role of family history and class II HLA genotypes". Eur. J. Endocrinol. 168 (1): 107–11. doi:10.1530/EJE-12-0541. PMID 23065995.
  4. Hekkala A, Ilonen J, Knip M, Veijola R (2011). "Family history of diabetes and distribution of class II HLA genotypes in children with newly diagnosed type 1 diabetes: effect on diabetic ketoacidosis". Eur. J. Endocrinol. 165 (5): 813–7. doi:10.1530/EJE-11-0376. PMID 21890652.
  5. Newton CA, Raskin P (2004). "Diabetic ketoacidosis in type 1 and type 2 diabetes mellitus: clinical and biochemical differences". Arch. Intern. Med. 164 (17): 1925–31. doi:10.1001/archinte.164.17.1925. PMID 15451769.
  6. Lin MV, Bishop G, Benito-Herrero M (2010). "Diabetic ketoacidosis in type 2 diabetics: a novel presentation of pancreatic adenocarcinoma". J Gen Intern Med. 25 (4): 369–73. doi:10.1007/s11606-009-1237-9. PMC 2842543. PMID 20119682.
  7. Casqueiro J, Casqueiro J, Alves C (2012). "Infections in patients with diabetes mellitus: A review of pathogenesis". Indian J Endocrinol Metab. 16 Suppl 1: S27–36. doi:10.4103/2230-8210.94253. PMC 3354930. PMID 22701840.
  8. Warner EA, Greene GS, Buchsbaum MS, Cooper DS, Robinson BE (1998). "Diabetic ketoacidosis associated with cocaine use". Arch. Intern. Med. 158 (16): 1799–802. PMID 9738609.
  9. Lewis KR, Clark C, Velarde MC (2014). "Socioeconomic factors associated with pediatric diabetic ketoacidosis admissions in Southern West Virginia". Clin. Endocrinol. (Oxf). 81 (2): 218–21. doi:10.1111/cen.12350. PMID 24117508.
  10. Westerberg DP (2013). "Diabetic ketoacidosis: evaluation and treatment". Am Fam Physician. 87 (5): 337–46. PMID 23547550.
  11. Roche EF, Menon A, Gill D, Hoey H (2005). "Clinical presentation of type 1 diabetes". Pediatr Diabetes. 6 (2): 75–8. doi:10.1111/j.1399-543X.2005.00110.x. PMID 15963033.
  12. Seth P, Kaur H, Kaur M (2015). "Clinical Profile of Diabetic Ketoacidosis: A Prospective Study in a Tertiary Care Hospital". J Clin Diagn Res. 9 (6): OC01–4. doi:10.7860/JCDR/2015/8586.5995. PMC 4525534. PMID 26266145.
  13. Barrett EJ, Sherwin RS (1983). "Gastrointestinal manifestations of diabetic ketoacidosis". Yale J Biol Med. 56 (3): 175–8. PMC 2589676. PMID 6419481.
  14. Kearney T, Dang C (2007). "Diabetic and endocrine emergencies". Postgrad Med J. 83 (976): 79–86. doi:10.1136/pgmj.2006.049445. PMC 2805944. PMID 17308209.

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