What is diabetic ketoacidosis, what causes diabetic ketoacidosis? What are its signs and symptoms, how can or is diabetic ketoacidosis treated. What are the treatment guidelines? How does one prevent the condition? What about treatment in children?
All these questions and more will be treated in this article.
Diabetic Ketoacidosis (DKA) is a potentially life threatening condition of diabetes occurring mostly in patients with Type 1 diabetes but on occasion also in patients with Type 2 diabetes.
Patients suffering from the condition will characteristically experience the following; ketoacidosis, hyperglycaemia and ketonuria. DKA happens due to a shortage of insulin in the body and so because the body is no longer able to derive the energy it needs from blood sugar, it switches over to burning fat as the alternative energy source. This produces acidic ketones responsible for most of the complications of the condition.
The most frequent early signs of Diabetic Ketoacidosis or DKA is a sharp increase in polydipsia and polyuria. Whilst Polydipsia means excessive thirst, Polyuria refers to the excessive production of dilute urine.
Other symptoms include malaise, generalized weakness, and tiredness. These may then progress if untreated to vomiting, deep gasping breathing (kussmaul respiration), dehydration, rapid weight loss in patients newly diagnosed with Type 1 diabetes, mild disorientation, confusion and occasionally coma.
Diabetic ketoacidosis occurs in 4.6-8.0% of people with type 1 diabetes annually. In the United States, 135,000 hospital admissions occur annually as a result of DKA at an estimated cost of a quarter to a half of the total cost of caring for people with type 1 diabetes-that’s a whopping $2.4 billion.
The belief is that this will increase as there has been an observed increase in hospital admissions. And people with ongoing risk factors such as eating disorder and those that cannot afford insulin are more prone to such hospitalisation.
Though DKA may be a symptom of undiagnosed diabetes, previously known sufferers may also come down with it as a result of several possible factors amongst which are poor compliance with insulin therapy or undercurrent illness. Where DKA results from undercurrent illness, the following symptoms, signs may be observed; coughing, fever, chills, chest pain, arthralgia, dyspnoea.
So how does one go about diagnosing DKA? This is done with blood and urine tests which will tend to reflect high blood sugar and ketones respectively. In addition, on physical examination, the patient may be observed to have dry skin, decreased reflexes, ill appearance, acetone (ketotic) breath often described as “fruity”, laboured respiration (kussmaul respiration), dry mucous membranes, decreased skin turgor and where the dehydration is severe enough to cause a decrease in the circulating blood volume, low blood pressure and tachycardia (a fast heart rate).
Other tests which may be helpful in diagnosing other aspects/complications of DKA include Head CT scanning (to detect possible early cerebral oedema), chest radiology (to rule out pulmonary infection such as pneumonia), head MRI where altered consciousness is present (to detect early cerebral oedema). Cerebral oedema (swelling of the brain tissue) may occur in children. Here because it increases intra-cranial pressure and ultimately leads to death, it is recommended that immediate counter-action- administration of hypertonic saline or mannitol should in such cases be made.
How does one treat diabetic ketoacidosis?
Treatment of ketoacidosis should have as its aims namely replenishment of fluid and electrolyte volume losses, reduction in the plasma glucose concentration to normal levels through the use of insulin, identification and treatment of the underlying cause, reversal of the acidosis and ketosis, and medicine.
Hyperglycaemia is corrected using analogue human insulin. These include rapid acting insulin’s; insulin glulsine, insulin lispro and insulin aspart and short-acting (regular) insulin.
Other medications used are Electrolyte supplements like potassium chloride and alkalizing agents like sodium bicarbonate although the use of the latter is somewhat discouraged because it may, it is said increase acidity inside the body’s cells and by so doing increase the risk of specific complications.
Treating Cerebral oedema on the other hand may actually require intensive care (unit) hospitalization, where artificial ventilation can be supplied and the patient closely observed. Here intravenous mannitol and hypertonic saline are used in an attempt to reduce the swelling.
A person suffering from diabetic ketoacidosis is said to have recovered when there is a general improvement in the symptoms of the condition. That is to say the return of blood acidity to normal levels (pH greater than 7.3), the ability to tolerate oral nutrition and fluids, and absence of ketones in the blood (less than 1mmol/1) or urine.
Giving insulin to the patient by injection can be returned to once this has been achieved and the intravenous administration discontinued one hour thereafter.