Diabetic ketoacidosis

Diabetic ketoacidosis (DKA) is a potentially life-threatening acute 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" or acetone smell.^[1] The 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 keto acids 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 glucose 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 continued to be a universally fatal condition until introduction of insulin therapy in the 1920s.^[7] With adequate and timely treatment, the risk of death is between <1% and 5%.^[1][6]