Symptoms of Diabetic Ketoacidosis

Diabetic ketoacidosis, or simply DKA, is one of the complications of diabetes mellitus. It occurs suddenly, is severe and can be life-threatening if neglected. The diabetic ketoacidosis is a complex metabolic state comprising of increased blood glucose levels (hyperglycemia), increased production and presence of ketone acids in the blood (ketonemia) and acidic changes in the internal environment of the body (acidosis). These changes together constitute the diabetic ketoacidosis.

Diabetic ketoacidosis is more common in persons with type – 1 as compared to type – 2 diabetes mellitus. Sometimes, it may be the first sign of diabetes mellitus in patients with no previous diagnosis of diabetes. In normal individuals, insulin hormone is produced and secreted by an organ called pancreas. Insulin is necessary for the entry of blood glucose into our cells. Insulin works like a key and unlocks the cellular gates to help glucose enter the cells. The cells use entered glucose to produce energy.

In type – 1 diabetes mellitus, the pancreatic cells producing insulin are destroyed. This lack of insulin prevents the entry of blood glucose into our cells as the cellular gates are closed, increasing the blood glucose levels (hyperglycemia). Our body cells starve and cannot utilize glucose for energy despite increased amounts of glucose in our blood. In this starving state, our body burns fats and produces ketones for energy purposes. Ketones have an advantage that they do not need insulin to enter into cells but the ketones also have a disadvantage that they are acidic in nature and when produced in excessive amounts, they change our body environment and make it acidic, which can be life-threatening.

The patients often develop ketoacidosis when:

They have missed their insulin doses

They have taken less than required insulin doses

They have developed fever

They have developed vomiting, diarrhea and dehydration

They had any physical injury or any surgery.

THE SYMPTOMS OF DIABETC KETOACIDOSIS:

The symptoms of diabetic ketoacidosis are as follows:

Increased Urination

Patients with diabetic ketoacidosis excrete frequent and large amounts of urine. The increased blood glucose cannot enter inside the body cells so it is filtered by our kidneys and is excreted in the urine. The glucose attracts water and hence increase amount of urine is formed.

Increased Thirst

The frequent and large excretions of urine cause severe dehydration in these patients. Patient feels intense thirst and craves for water and fluids.

Dehydration

In DKA, the patient loses more fluids in the form of excessive urination than the fluid intake. The patient becomes dehydrated. The degree of dehydration increases with the passing time. In spite of dehydration, kidney keeps on producing large amounts of urine exacerbating the condition. In dehydrated persons, there is dryness of mouth and skin, decreased blood pressure, and weak rapid pulse.

Generalized weakness

Patient with DKA experiences generalized weakness, malaise, and fatigue. The excessive urinary loss of glucose, fluids and electrolytes make the patient sick and is responsible for such experiences.



Abdominal Pain

The patients with DKA complain of abdominal pain. The pain is usually all over the abdomen and is mild to moderate in severity. Sometimes the pain is very severe resembling the surgical causes and additional tests may be required for the accurate diagnosis.

Rapid Breathing

Patients with diabetic ketoacidosis breathe very rapidly. They have air-hunger and they want to catch as much air as possible. The rate of breathing is proportional to the metabolic acidosis i.e. severe the acidosis, the rapid the breathing rate. The patient tries to blow off the carbon dioxide to neutralize the metabolic acidosis.

Confusion, Drowsiness, and Loss of Consciousness

Patients with diabetic ketoacidosis may be confused or drowsy and may develop altered consciousness. The frank coma is not common. These changes occur when the condition is neglected for prolonged time or is very severe.

Smell of Ketones

Patients may have a smell of ketones in their breath that resembles the nail-polish remover or pear drops.

Other symptoms

Patients may also have the other symptoms that precipitated the diabetic ketoacidosis, such as fever or other symptoms of infection such as cough, burning micturition, diarrhea, vomiting or even sore throat.

It should be remembered that diabetic ketoacidosis is a medical emergency. If you or your loved one is diabetic and has the above-mentioned symptoms, you should immediately contact your healthcare provider or go to an emergency room directly.

If your blood glucose is more than 300 milligrams/deciliter, you should check for urine ketones using the ketone strips. The presence of moderate to severe ketones on the urine strip should require immediate consultation with your healthcare provider.



References

Longo, D., Fauci, A., Kasper, D., & Hauser, S. Harrison’s Principles of Internal Medicine 18th edition. McGraw-Hill Professional. pp 2976-2979.

McPhee S.J., Papadakis M.A. Current Medical Diagnosis and Treatment 2016. Lange McGraw Hill. pp 1225-1229.

Hamdy, O. Diabetic Ketoacidosis Clinical Presentation. Retrieved from: http://emedicine.medscape.com/article/118361-clinical Date assessed: 28th April, 2016.

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