DKA; Ketoacidosis; Diabetes - ketoacidosis
Diabetic ketoacidosis (DKA) is a life-threatening problem that affects people with diabetes. It occurs when the body starts breaking down fat at a rate that is much too fast. The liver processes the fat into a fuel called ketones, which causes the blood to become acidic.
DKA happens when the signal from insulin in the body is so low that:
The fat is broken down by the liver into a fuel called ketones. Ketones are normally produced when the body breaks down fat after a long time between meals. When ketones are produced too quickly and build up in the blood and urine, they can be toxic by making the blood acidic. This condition is known as ketoacidosis.
DKA is sometimes the first sign of type 1 diabetes in people who have not yet been diagnosed. It can also occur in someone who has already been diagnosed with type 1 diabetes. Infection, injury, a serious illness, missing doses of insulin shots, or surgery can lead to DKA in people with type 1 diabetes.
People with type 2 diabetes can also develop DKA, but it is less common and less severe. It is usually triggered by prolonged uncontrolled blood sugar, missing doses of medicines, or a severe illness or infection.
Common symptoms of DKA can include:
Ketone testing is usually done when DKA is suspected:
Other tests for ketoacidosis include:
The goal of treatment is to correct the high blood sugar level with insulin. Another goal is to replace fluids lost through urination, loss of appetite, and vomiting if you have these symptoms.
If you have diabetes, it is likely your health care provider told you how to spot the warning signs of DKA. If you think you have DKA, test for ketones using urine strips. Some glucose meters can also measure blood ketones. If ketones are present, call your provider right away. DO NOT delay. Follow any instructions you are given.
It is likely that you will need to go to the hospital. There, you will receive insulin, fluids, and other treatment for DKA. Then providers will also search for and treat the cause of DKA, such as an infection.
Most people respond to treatment within 24 hours. Sometimes, it takes longer to recover.
If DKA is not treated, it can lead to severe illness or death.
Health problems that may result from DKA include any of the following:
DKA is often a medical emergency. Call your provider if you notice symptoms of DKA.
Go to the emergency room or call the local emergency number (such as 911) if you or a family member with diabetes has any of the following:
If you have diabetes, learn to recognize the signs and symptoms of DKA. Know when to test for ketones, such as when you are sick.
If you use an insulin pump, check often to see that insulin is flowing through the tubing. Make sure the tube is not blocked, kinked or disconnected from the pump.
American Diabetes Association. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes - 2019. Diabetes Care. 2019;42(Suppl 1):S13-S28. PMID: 30559228 www.ncbi.nlm.nih.gov/pubmed/30559228.
Maloney GE, Glauser JM. Diabetes mellitus and disorders of glucose homeostasis. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 118.
Pasquel FJ, Umpierrez GE. Hyperglycemic crises: diabetic ketoacidosis and hyperglycemic hyperosmolar state. In: Jameson JL, De Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric. 7th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 46.BACK TO TOP
Review Date: 1/16/2018
Reviewed By: Brent Wisse, MD, board certified in Metabolism/Endocrinology, Seattle, WA. Internal review and update on 07/10/2019 by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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