Definition of DKA

• DKA is a life-threatening but reversible, metabolic decomposition -- a diabetes complication characterized by severe disturbances in fluid balance and protein, fat, and carbohydrate metabolism. The events that lead to DKA include hyperglycemia (which causes excess urine and electrolyte losses, leading to dehydration) and acidosis (brought about by incomplete oxidation of fatty acids).
• Anyone with diabetes may experience DKA, especially during illness. However, DKA is most common in patients with Type I diabetes.

Cause

• Relative insulin deficiency and excessive counter-regulatory hormones.

  Precipitating factors contributing to a relative insulin deficiency include:

  • inadequate insulin replacement during sick day
  • infection
  • trauma
  • heart attack, stroke, etc.
  • increased stress hormones
  • deliberate or inadvertent omission of insulin treatment

Symptoms

• Nausea and vomiting
• Thirst and polyuria
• Weakness and/or anorexia
• Abdominal pain
• Visual disturbances
• Somnolence

Signs

• Tachycardia - a fast pulse
• Hypotension
• Dehydration
• Warm dry skin
• Hyperpnoea or Kussmaul breathing ("air hunger")
• Impaired consciousness and/or coma
• Weight loss
• Fruity breath odor of ketones

Treatment

• Fluid and electrolyte replacement
• Insulin
• Treatment of the underlying precipitating event, such as infection

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