Clinical Overview
Reviewed by Michael Fuller, MD

Diabetic ketoacidosis (DKA) occurs when inadequate insulin levels cause high blood sugar, which leads to organic acids and ketones in the blood. DKA often involves severe dehydration and blood chemistry abnormalities. Left untreated, DKA progresses to diabetic coma and is often fatal.

DKA occurs when the body has no or very little insulin. Insulin is the hormone responsible for enabling cells to absorb glucose, the simple sugar that enters the bloodstream during digestion and is the source of cellular energy.
When cells are unable to use glucose in the blood as fuel, other hormones cause fat within the cells to break down into glucose and fatty acids called ketones. In effect, the body thinks it is starving, so it goes into emergency prevention mode by metabolizing fat, muscle, and liver cells to create fuel.
Once these molecules are broken down, the system is flooded with glucose. Together with the glucose already in the blood due to the shortage of insulin, a situation of extremely elevated blood sugar is created. In response to the unsafe levels of sugar in the blood, the body increases urination, causing dehydration and loss of the electrolyte potassium, which is necessary for cellular respiration. The changes to blood chemistry also cause the blood to become dangerously acidic, which in extreme cases can result in the denaturing of enzymes and proteins in the system, causing permanent tissue damage and organ failure.
Symptoms and signs of DKA include many of the symptoms of extreme dehydration. They may include:
• Extreme thirst and cravings for fluids
• Frequent urination
• Weakness and fatigue
• Vomiting
• Loss of appetite
• Confusion, disorientation
• Abdominal pain
• Shortness of breath, rapid breathing
• Dry mouth and skin
• Racing heart
• Low blood pressure
• A distinctive fruity odor on the breath
• Muscle wasting
• Fungal infections, such as oral or vaginal yeast infections, that fail to clear up

DKA is most common in people under 25 years of age who have type 1 diabetes. Forty percent of cases of DKA are caused by infection; other common causes include failure to take prescribed insulin, or new or previously undiagnosed diabetes. Heart attack, stroke, trauma, stress, and surgery may also cause DKA. As many as one in ten cases cannot be traced to a specific cause.

Last updated: Dec-17-07