Diabetic ketoacidosis (DKA) is a complication affecting 4.6–8.0 per 1000 type 1 diabetic patients. Every year 100,000 hospital admissions in the United States are caused by this ailment. An estimated $1 billion is the cost government bears for this disease. 30 percent type 1 diabetic children have an experience of DKA. This article tries to gain further insight on this condition.
Insulin is responsible for carrying glucose or energy to the cells of the body. This energy is either utilized by the cells for carrying out their functions or is stored as fats for later use. When there is absence of this hormone, the glucose level starts rising in the blood itself. This is the undesirable condition called diabetes mellitus.
Absolute shortage of the hormone insulin causes DKA. The body is compelled to burn the stored fatty acids in the cells. In this process, substances called acidic ketone bodies are produced which are responsible for most of the signs of DKA.
Diabetic patients are at higher risks of getting this disease. Pre-diabetic patients are diagnosed with DKA in the initial stages. Illness like heart disease, stroke, influenza, pneumonia, gastroenteritis and conditions like eating disorder, pregnancy and use of cocaine can lead to DKA. It is prevalent among African, Hispanic and African-American people.
Symptoms of Diabetic Ketoacidosis:
- Coma
- Vomiting
- Nausea
- Breath odor
- Breathing difficulty
- Confusion
- Abdominal pain
- Rapid pulse
- Drowsiness
- Sweet smelling acetone breath
- Rapid breathing
- Dehydration
- Low blood pressure
- Headache due to swelling of brain tissue
- Tender abdomen
- Excessive thirst
- Excessive urine production
- Lethargy
- Stupor
- Loss of the pupillary light reflex
Blood and urine tests can diagnose this condition. Acidity of blood and presence of bicarbonate in the urine is checked. Normally the pH of blood is between 7.35-7.45. The bicarbonate is normally above 20 mmol/l. According to the American Diabetes Association, the severity of DKA in adults can be categorized in three stages. They are:
Mild: If blood pH is between 7.25-7.30 and bicarbonate level is between 15-18 mmol/l.
Moderate: If blood pH is between 7.00-7.25 and bicarbonate level is between 10-15 mmol/l.
Severe: If blood pH is between below 7.00 and bicarbonate level is below 10 mmol/l.
Treatment of Diabetic Ketoacidosis: The goal of treatment is to replace the lost fluids and suppress the blood sugar levels and ketone production with insulin. Some of the methods employed are:
Fluid Replacement: Quick saline infusion up to 10ml/kg in repeated doses should be given to adults for treating severe case of dehydration.
Insulin: Ketone production and blood sugar level is brought under control by giving insulin at 0.1 unit/kg per hour. However, there is difference in opinions and guidelines on the amount of insulin given once the blood sugar level decreases.
Potassium: Insulin reduces the potassium levels by distributing it among body cells. If its level falls below 3.3mmol/l, insulin insertion should be stopped. Low potassium concentration can lead to irregularities in heart beats. That is why, heart beats are to be monitored with repeated measurement of potassium levels.
