Diabetic ketoacidosis (DKA) is an acute complication of diabetes that is a life-threatening emergency. It is more common in patients with type 1 diabetes, but may also occur in type 2 diabetes. Some patients find out that they have diabetes after coming into the hospital with DKA. It occurs because the body is not able to process sugar (glucose) correctly, and goes into "starvation mode." In this mode, the body breaks down fat for energy, and acidic molecules called ketones are produced. A variety of symptoms may be the result of diabetic ketoacidosis; if you suspect DKA, bring it to the attention of your medical care provider immediately.
Symptoms of a Recent Illness
Often, a viral illness or other infection may "tip" a patient into DKA; this is because when a person is sick (with a cold or upper respiratory infection, for instance), the body needs more insulin than usual. Since insulin is not available, DKA may occur. So patients may have a cough, runny nose, or symptoms that are due to the underlying infection, not the DKA itself.
Fatigue or Weakness
A person in DKA may feel fatigued for several reasons: he may have a cold or other infection causes fatigue (see above). Additionally, high levels of sugar in the blood (hyperglycemia) dry out the body, and dehydration can cause a feeling of extreme tiredness and weakness.
Rapid Breathing
A person in DKA often has a characteristic breathing pattern known as Kussmaul's respirations: these are deep and fast breaths that occur because the body is trying to blow off the extra acid that is being produced.
Thirst and Frequent Urination
These are classic symptoms of high blood sugar, and occur because the body is no longer able to take sugar into the cells. Instead, sugar (derived from the foods we eat) remains in the bloodstream and "pulls" water out of the cells of the body. This results in frequent urination and a feeling of unquenchable thirst.
Nausea and Vomiting
In up to 25 percent of cases, DKA is associated with nausea and vomiting; this is likely due to the high levels of sugar in the blood, which can make a person feeling nauseated and result in vomiting.
Fruity Breath
One of the ketone molecules produced in DKA is called acetone (some nail polish removers contain this substance); since the body is abnormally making this substance, the breath may actually take on the distinct "fruity" odor of acetone.
Confusion or Coma
As the levels of blood sugar rise to extremely high levels, a person in DKA may begin to feel confused or disoriented. In the worst cases of DKA, a person may actually go into a coma.
References
- "Greenspan's Basic & Clinical Endocrinology"; David Gardner and Dolores Shoback; 2007
- "CURRENT Diagnosis and Treatment Emergency Medicine"; C. Keith Stone; 2007
