| Dehydration may be severe in diabetic ketoacidosis, and intravenous fluids are usually needed as part of its treatment. |
| Endocrinology |
| Vomiting, abdominal pain, deep gasping breathing, increased urination, confusion, a specific smell[1] |
| Cerebral edema[2] |
| Relatively rapid[1] |
| Shortage of insulin[3] |
| Usually type 1 diabetes, less often other types[1] |
| High blood sugar, low blood pH, ketoacids[1] |
| Hyperosmolar nonketotic state, alcoholic ketoacidosis, uremia, salicylate toxicity[4] |
| Intravenous fluids, insulin, potassium[1] |
| 4–25% of people with type 1 diabetes per year[1][5] |
Diabetic ketoacidosis [DKA] is a potentially life-threatening complication of diabetes mellitus.[1] Signs and symptoms may include vomiting, abdominal pain, deep gasping breathing, increased urination, weakness, confusion and occasionally loss of consciousness.[1] A person's breath may develop a specific "fruity" smell.[1] Onset of symptoms is usually rapid.[1] People without a previous diagnosis of diabetes may develop DKA as the first obvious symptom.[1]
DKA happens most often in those with type 1 diabetes but can also occur in those with other types of diabetes under certain circumstances.[1] Triggers may include infection, not taking insulin correctly, stroke and certain medications such as steroids.[1] DKA results from a shortage of insulin; in response, the body switches to burning fatty acids, which produces acidic ketone bodies.[3] DKA is typically diagnosed when testing finds high blood sugar, low blood pH and ketoacids in either the blood or urine.[1]
The primary treatment of DKA is with intravenous fluids and insulin.[1] Depending on the severity, insulin may be given intravenously or by injection under the skin.[3] Usually, potassium is also needed to prevent the development of low blood potassium.[1] Throughout treatment, blood sugar and potassium levels should be regularly checked.[1] Underlying causes for the DKA should be identified.[6] In those with severely low blood pH who are critically ill, sodium bicarbonate may be given; however, its use is of unclear benefit and typically not recommended.[1][6]
Rates of DKA vary around the world.[5] Each year, about 4% of type 1 diabetics in the United Kingdom develop DKA, versus 25% of type 1 diabetics in Malaysia.[1][5] DKA was first described in 1886, and until the introduction of insulin therapy in the 1920s, it was almost universally fatal.[7] With adequate and timely treatment, the risk of death is between