What are the first signs that a person is experiencing diabetic ketoacidosis
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For some children, a diagnosis of diabetes comes only after they experience diabetic ketoacidosis (DKA), a potentially life-threatening condition. If your child has diabetes or is at risk for diabetes due to a family history or other factors, understanding DKA and its symptoms can help you respond quickly and get your child the necessary care. Huay-Lin Lo, M.D., Pediatric Endocrinologist at Children's Health℠ and Assistant Professor at UT Southwestern, shares important information on DKA. Show
What is diabetic ketoacidosis?Diabetic ketoacidosis, or DKA, is a serious and potentially life-threatening complication of diabetes. Up to 70% of the time, when a child is first diagnosed with diabetes, it's because they are experiencing DKA. "Children who are developing diabetes have low levels of insulin, a hormone the body uses to absorb blood sugar – the major source of energy for the muscles and other tissues," says Dr. Lo. "When insulin is too low, the body can't use sugar in the blood appropriately. Instead, the body begins to burn fat for energy." The liver turns the fat into ketones, a type of fuel. However, ketones are acids, and when there are high levels of ketones in the blood, the blood becomes too acidic. This can be toxic, causing a wide range of problems. What causes diabetic ketoacidosis?When the body can't use sugar for energy properly, hormones are released that break down fat as fuel, producing ketones. In a person with low insulin levels, the excess ketones build up in the blood faster than they can be consumed as fuel, leading to DKA. There are several reasons a child may have large amounts of ketones:
What are the symptoms of DKA?It's essential to know the signs and symptoms of DKA in children, to help recognize it early and ensure timely, targeted therapy. "DKA has similar symptoms as some common illnesses, which can make it hard to detect," says Dr. Lo. "Know the signs and make sure to talk to your child's doctor about these symptoms if you are concerned." Signs and symptoms of DKA include frequent urination, increased thirst, increased hunger, unexplained weight loss and flu-like symptoms.
DKA is a serious condition. Always seek medical attention from your pediatrician or another medical professional if your child has the above symptoms. Early recognition can help lessen the severity of DKA in a child and possibly save a child's life. Learn moreThe nationally recognized diabetes program at Children's Health offers around-the-clock care for children with diabetes. Learn how our experts can help diagnose and treat diabetes in children of all ages. Sign up for Endocrine EssentialsDiscover what’s new in diabetes care and hormonal health. Sign up for the monthly newsletter from the Endocrinology team at Children’s Health. Diabetic ketoacidosis is an acute complication of diabetes that occurs mostly in type 1 diabetes mellitus.
(See also Diabetes Mellitus Diabetes Mellitus (DM) Diabetes mellitus is a disorder in which the body does not produce enough or respond normally to insulin, causing blood sugar (glucose) levels to be abnormally high. Urination and thirst are... read more .) There are two types of diabetes mellitus, type 1 and type 2. In both types, the amount of sugar (glucose) in the blood is elevated. Glucose is one of the body's main fuels. Insulin, a hormone produced by the pancreas, helps glucose move from the blood into the cells. Once glucose is inside the cells, it is either converted to energy or stored as fat or glycogen until it is needed. When there is not enough insulin, most cells cannot use the glucose that is in the blood. Because cells still need energy to survive, they switch to a back-up mechanism to obtain energy. Fat cells begin breaking down, producing compounds called ketones. Ketones provide some energy to cells but also make the blood too acidic (ketoacidosis). Ketoacidosis that occurs in people with diabetes is called diabetic ketoacidosis. Diabetic ketoacidosis occurs mainly in people who have because their body produces little or no insulin. However, rarely, some people with develop ketoacidosis. People who abuse alcohol also can develop ketoacidosis (alcoholic ketoacidosis Alcoholic Ketoacidosis Alcoholic ketoacidosis is a complication of alcohol use and starvation that causes excess acid in the bloodstream, resulting in vomiting and abdominal pain. (See also Diabetes Mellitus.) People... read more ). Unlike in diabetic ketoacidosis, blood glucose levels are usually only mildly elevated. Causes of Diabetic KetoacidosisDiabetic ketoacidosis is sometimes the first sign that people (usually children—see also Diabetes Mellitus (DM) in Children and Adolescents Diabetes Mellitus (DM) in Children and Adolescents Diabetes mellitus is a disorder in which blood sugar (glucose) levels are abnormally high because the body does not produce enough insulin or fails to respond normally to the insulin produced... read more
An illness usually increases the body's need for energy. Thus, when people become ill, they often need more insulin to move extra glucose into their cells. If people do not take extra insulin when they are ill, they can develop diabetic ketoacidosis. Common illnesses that can trigger diabetic ketoacidosis include
Rarely, some medications, especially the sodium-glucose co-transporter-2 (SGLT-2) inhibitors, can cause diabetic ketoacidosis, even in people with type 2 diabetes. Some people with type 2 diabetes are prone to develop ketoacidosis. This type of diabetes is called ketosis-prone diabetes, but is sometimes referred to as Flatbush diabetes. This type of diabetes is an unusual variant that is more likely to occur in people with obesity and in people of African ancestry. Symptoms of Diabetic KetoacidosisThe initial symptoms of diabetic ketoacidosis include excessive thirst and urination, weight loss, nausea, vomiting, fatigue, and—particularly in children—abdominal pain. Breathing tends to become deep and rapid as the body attempts to correct the blood’s acidity Acidosis Acidosis is caused by an overproduction of acid that builds up in the blood or an excessive loss of bicarbonate from the blood (metabolic acidosis) or by a buildup of carbon dioxide in the blood... read more . The breath has a fruity odor similar to nail polish remover because of the smell of the ketones escaping into the breath. Without treatment, diabetic ketoacidosis can progress to coma and death (especially in children). Diagnosis of Diabetic Ketoacidosis
Doctors diagnose diabetic ketoacidosis by measuring the level of ketones and acid in the blood and urine. People with diabetic ketoacidosis also have high blood glucose levels, but people may have high glucose levels without having diabetic ketoacidosis (see Hyperosmolar, Hyperglycemic State Hyperosmolar Hyperglycemic State (HHS) Hyperosmolar hyperglycemic state is a complication of diabetes mellitus that most often occurs in type 2 diabetes. Symptoms of hyperosmolar hyperglycemic state include extreme dehydration and... read more ). Doctors typically also do tests, such as a chest x-ray and urine analysis, to look for an underlying infection and electrocardiography (ECG) to look for a heart attack. Treatment of Diabetic Ketoacidosis
Diabetic ketoacidosis is a medical emergency. Hospitalization, usually in an intensive care unit, may be necessary. Large amounts of fluids are given intravenously along with electrolytes, such as sodium, potassium, chloride, and sometimes phosphate, to replace those fluids and electrolytes lost through excessive urination. Insulin is generally given intravenously so that it works quickly and the dose can be adjusted frequently. Blood levels of glucose, ketones, and electrolytes are measured every few hours. Doctors also measure the blood’s acid level. Sometimes, additional treatments are needed to correct a high acid level. However, controlling the levels of glucose in the blood with insulin and, giving fluids, and replacing electrolytes usually allow the body to restore the normal acid-base balance. More InformationThe following English-language resources may be useful. Please note that THE MANUAL is not responsible for the content of the resources.
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