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Definition

Diabetic ketoacidosis is a complication of diabetes that occurs when sugar (glucose) is not available as a fuel source by the body and fat is used instead. Byproducts of fat breakdown, called ketones, build up in the body.

Alternative Names

DKA; Ketoacidosis

Causes, incidence, and risk factors

People with Type I diabetes lack enough insulin, a hormone the body uses to process sugar (glucose) for energy. When glucose is not available, body fat is broken down instead.

The byproducts of fat metabolism are ketones and acid. When fat is broken down, ketones and acid build up in the blood. A condition called ketoacidosis develops when the blood has more acid than normal.

Blood glucose levels rise (usually higher than 300 mg/dL) because the liver produces glucose to try to combat the problem. However the cells cannot pull in that glucose without insulin.

Diabetic ketoacidosis may lead to a diagnosis of type 1 diabetes, because it is often the first symptom that causes a person to see a doctor. It can also be the result of increased insulin needs in someone already diagnosed with type 1 diabetes. Infection, trauma, heart attack, or surgery can lead to diabetic ketoacidosis in such cases. Missing doses of insulin can also lead to ketoacidosis in people with diabetes.

People with type 2 diabetes can develop ketoacidosis, but it is rare. It is usually triggered by a severe illness. People of Hispanic and African-American ethnicity seem to be more likely to have ketoacidosis as a complication of type 2 diabetes.

Symptoms

• Fatigue
• Frequent urination or thirst for a day or more
• Fruity breath (breath odor)
• Mental stupor that may progress to coma
• Muscle stiffness or aching
• Nausea and vomiting
• Rapid breathing
• Shortness of breath

Other symptoms that can occur with this disease:

• Abdominal pain
• Breathing difficulty while lying down
• Decreased appetite
• Decreased consciousness
• Headache

Reviewer Info: Elizabeth H. Holt, MD, PhD, Assistant Professor of Medicine, Section of Endocrinology and Metabolism, Yale University. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc., 06/17/2008