Diabetic ketoacidosis

Diabetic ketoacidosis is a complication of diabetes mellitus where the blood becomes far too acidic with an elevation of blood ketones. It is usually due to a lack of insulin.

Diabetic ketoacidosis is the result from a severe insulin deficiency. Insulin is a hormone secreted by the body to convert glucose into energy. People with diabetes mellitus do not produce enough insulin or do not respond properly to insulin.

Insulin deficiency avoids the transport of energy to the cells. As a consequence, the body use store fats as an alternative source of energy that creates acidic ketones. It produces a high presence of acidic ketones in the blood because they also require insulin to be broken down. The presence of excess ketones in the bloodstream causes the blood to become more acidic than the body tissues, which creates a toxic condition.

Diabetic ketoacidosis has three main features:

• Hyperglycemia (high blood sugar)
• Hyperketonemia (elevated blood ketones)
• Metabolic acidosis (the blood PH becomes too acidic)

In childhood diabetes, diabetic ketoacidosis is a risk because it can lead to cerebral edema (accumulation of abnormally large amounts of fluid in the brain) that may finally cause the death.

Diabetic ketoacidosis is common in patients with type I diabetes, under 19 years of age and is usually caused by the interruption of their insulin treatment or by acute infection or trauma. Approximately half the cases of diabetic ketoacidosis are precipitated by infection.

A small number of patients with type II diabetes also experience ketoacidosis, but this is rare because type II diabetics still produce some insulin naturally. When diabetic ketoacidosis occurs in type II patients, it is usually caused by a decrease in food intake (starvation) and an increased insulin deficiency due to hyperglycemia.

The incidence of diabetic ketoacidosis is between 4.6 to 8.0 cases per 1000 inhabitants per year, among patients with diabetes.

The main common symptoms of diabetic ketoacidosis are:

• Frequent urination (polyuria)
• Extreme thirstiness (polydipsia)
• Fatigue
• Nausea and vomiting
• Diarrhea
• Dehydration
• Abdominal pain
• Muscle stiffness or aching
• Fruity-smelling breath (keto breath)
• Deep and labored breathing (Kussmaul breathing)

If the symptoms persist, it can lead to mental status changes.

The diagnosis of the disease is usually based on the main features of the disease:

• Hyperglycemia: Sugar (glucose) levels exceed 250 mg/dl and can reach 400 to 800 mg/dL
• Hyperketonemia: There is an increase level of ketones in the blood and urine.
• Acidosis: A low serum bicarbonate level (usually below 15 mEq/L) is present, the arterial blood pH is below 7.35 and the venous blood pH is below 7.30.

Diabetic ketoacidosis is treated under medical supervision and usually in a hospital because it is considered a medical emergency. Basic treatment includes:

• Intravenous insulin therapy to correct the hyperglycemia and hyperketonemia.
• Fluid and electrolyte therapy (sodium, potassium and bicarbonate, etc.) intravenously (saline solutions) to replace fluids lost through excessive urination and vomiting.

Diabetic ketoacidosis is a potentially fatal metabolic disorder that can have a significant mortality if misdiagnosed or mistreated.

The diabetic ketoacidosis mortality rate is about 1%. Coma on admission adversely affects the prognosis.

With proper medical attention, diabetic ketoacidosis is almost always successfully treated.

To avoid diabetic ketoacidosis it is very important for diabetic patients a regular monitoring of blood sugar. Blood sugar monitoring is especially important during periods of stress, infection, and trauma.

In addition, prevention measures to avoid diabetic ketoacidosis include administration of insulin according to medical recommendations and lifestyle maintenance.