Ketoacidosis is a metabolic state associated with pathologically high serum and urine concentrations of ketone bodies. It can take several forms, including diabetic ketoacidosis (DKA), alcoholic ketoacidosis (AKA), and starvation ketoacidosis (SKA).
Diabetic Ketoacidosis (DKA) occurs when the body cannot produce enough insulin, resulting in fat being used for energy production. This typically happens when an individual has very high blood glucose and low insulin levels. Therefore, a combination of hyperglycemia and insulin deficiency can result in DKA, producing high levels of ketone bodies, namely acetone, acetoacetate, and beta-hydroxybutyrate. When insulin levels are deficient, combined with high glucose levels, the pancreas is also stimulated to produce higher glucagon levels.
Therefore, a combination of hyperglycemia, low insulin levels, and high glucagon levels can cause the body to be unable to metabolize glucose for energy. As a result, the body instead utilizes fatty acid metabolism for energy production. In turn, the metabolism of fatty acids leads to an increased production of ketone bodies, which eventually causes metabolic acidosis, resulting in diabetic ketoacidosis (DKA).
DKA is a serious complication of diabetes and can be life-threatening. It is most common among individuals with type 1 diabetes; however, some individuals (10–30%) with type 2 diabetes can also develop the condition. Symptoms of DKA can include one or more of the following: being very thirsty, urinating more than usual, deep, fast breathing, dry skin and mouth, flushed face, fruity-smelling breath, headache, muscle stiffness or aches, being very tired, stomach pain with nausea and vomiting.
Besides the various symptoms of DKA, the condition is diagnosed by testing the blood or urine for ketones. Elevated levels of ketones can be an early sign of DKA. Typically, the condition is diagnosed when the following occur:
- Blood glucose remains at 300 mg/dL or higher
- Blood or urine Ketones are elevated
- Breath smells fruity
- Other multiple symptoms and signs of DKA occur
Treatment and Prevention of DKA
Individuals with DKA are treated in the emergency room or admitted to the hospital. Treatment usually includes replacing fluid loss and electrolytes, receiving insulin, and taking medications for any underlying illness that could cause DKA.
Several steps can be taken to prevent DKA. Prevention usually begins with the following:
- Check blood glucose levels often and monitor for high or low levels.
- Keep blood glucose levels in a target range as much as possible.
- Adjust insulin as needed and recommended by the clinician.
For additional information on hyperglycemia, hypoglycemia, and diabetic ketoacidosis (DKA), please consult the following reference links:
