Diabetic Ketoacidosis

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Medical Author:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Medical Editor:

Robert Ferry Jr., MD

Robert Ferry Jr., MD

Robert Ferry Jr., MD, is a U.S. board-certified Pediatric Endocrinologist. After taking his baccalaureate degree from Yale College, receiving his doctoral degree and residency training in pediatrics at University of Texas Health Science Center at San Antonio (UTHSCSA), he completed fellowship training in pediatric endocrinology at The Children's Hospital of Philadelphia.

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• Diabetic Ketoacidosis Overview
• Diabetic Ketoacidosis Causes
• Diabetic Ketoacidosis Symptoms
• When to Seek Medical Care
• Exams and Tests
• Diabetic Ketoacidosis Treatment
• Self-Care at Home
• Medical Treatment
• Next Steps
• Follow-up
• Prevention
• Outlook
• Support Groups and Counseling
• For More Information
• Web Links
• Synonyms and Keywords
• Authors and Editors
• Viewer Comments: Diabetic Ketoacidosis - Symptoms

Diabetic Ketoacidosis Overview

Diabetic ketoacidosis (DKA) results from dehydration during a state of relative insulin deficiency, associated with high blood levels of sugar level and organic acids called ketones. Diabetic ketoacidosis is associated with significant disturbances of the body's chemistry, which resolve with proper therapy.

Diabetic ketoacidosis usually occurs in people with type 1 (juvenile) diabetes mellitus (T1DM), but diabetic ketoacidosis can develop in any person with diabetes. Since type 1 diabetes typically starts before age 25 years, diabetic ketoacidosis is most common in this age group, but it may occur at any age. Males and females are equally affected.

Diabetic Ketoacidosis Causes

Diabetic ketoacidosis occurs when a person with diabetes becomes dehydrated. As the body produces a stress response, hormones (unopposed by insulin due to the insulin deficiency) begin to break down muscle, fat, and liver cells into glucose (sugar) and fatty acids for use as fuel. These hormones include glucagon, growth hormone, and adrenaline. These fatty acids are converted to ketones by a process called oxidation. The body consumes its own muscle, fat, and liver cells for fuel.

In diabetic ketoacidosis, the body shifts from its normal fed metabolism (using carbohydrates for fuel) to a fasting state (using fat for fuel). The resulting increase in blood sugar occurs, because insulin is unavailable to transport sugar into cells for future use. As blood sugar levels rise, the kidneys cannot retain the extra sugar, which is dumped into the urine, thereby increasing urination and causing dehydration. Commonly, about 10% of total body fluids are lost as the patient slips into diabetic ketoacidosis. Significant loss of potassium and other salts in the excessive urination is also common.

The most common events that cause a person with diabetes to develop diabetic ketoacidosis are:

• infection such as diarrhea, vomiting, and/or high fever (40%),
  
  
• missed or inadequate insulin (25%), and
  
  
• newly diagnosed or previously unknown diabetes (15%).

Various other causes may include a heart attack, stroke, trauma, stress, alcohol abuse, drug abuse, and surgery. Approximately 5% to 10% of cases have no identifiable cause.