What is diabetic ketoacdosis?

Diabetic ketoacidosis is due to severe insulin deficiency characterized by hyperglycemia, ketoacidosis and dehydration.

* Hyperglycemia over 300 mg/dL

* Low bicarbonate (<15 mEq/L)

* Acidosis (pH <7.30)

* Ketonemia and ketonuria.

Most commonly seen in type 1 diabetes. Sometimes it would be the presenting feature. It also seen in type 2 diabetes but not as common as and not as severe as type 1 diabetes.

Risk factors:

* Insufficient insulin therapy

* Infections

* Surgery

* emotional stress

* Excess alcohol intake

Clinical findings include loss of appetite, vomiting, pain in the belly, fast and deep breathing, altered mental status. When you go near the patient, you will smell a fruity smell because of some substances in the blood like acetone, acetoacetate. There will be increased levels of glucose in blood, increased serum levels of substances like acetone, acetoacetate and low blood base.

What causes diabetic ketoacidosis?

In diabetes we all know that there is insulin deficiency. Beta cells are damaged so there are not enough in number to secrete insulin. Once insulin is deficient, the glucose in the blood is not used by the cells like adipose cells and muscle cells. So they start using fats and proteins as their fuel for energy. So instead of glucose as fuel, fats and protein are used for energy in spite of excess glucose the body.

Increased fatty acids goes to liver and converted to ketones. Aminoacids from muscle protein goes to liver and changed to glucose. Hormone glucagon increased which implicated in glucose creation by the liver. This causes further increase in blood glucose and ketones leading to ketosis and coma. There is also aletered blood chemistry like body potassium is low, increase in urea and creatinine because of dehydration. Hyperglycemia draws water in kidneys and more urine will be passed by the patient called polyuria.

When to call doctor?

* When you missed your insulin doses in case of stress, infections.

* When you are feeling weak, ill, dehydated, abdominal pain etc.

* When your glucose levels are increasing inspite of insulin therapy.

* Increased blood glucose like 300 mg/dl on your home monitoring device.

* Vomitings, fever.

How is it managed?

Diabetic ketoacidosis is a very serious complication that needs an immediate medical attention and hospital admission. Doctors will treat this condition by insulin and fluid replacement. With modern fluid management, the mortality rate of ketoacidosis is about 2% per episode.After discharge from the hospital, the patient is advised to monitor glucose at least 4 times a day and contact his physician if there is any symptoms etc.

Tags: diabetic, type 1 diabetes, diabetes, diabetic ketoacdosis