If you feel ill or stressed or you've had a recent illness or injury, check your blood sugar level often. You might also try an over-the-counter urine ketones testing kit. Sugar is a main source of energy for the cells that make up your muscles and other tissues. Normally, insulin helps sugar enter your cells. Without enough insulin, your body can't use sugar properly for energy.
This prompts the release of hormones that break down fat as fuel, which produces acids known as ketones. Excess ketones build up in the blood and eventually "spill over" into the urine. Uncommonly, diabetic ketoacidosis can occur if you have type 2 diabetes.
In some cases, diabetic ketoacidosis may be the first sign that you have diabetes. Diabetic ketoacidosis is treated with fluids, electrolytes — such as sodium, potassium and chloride — and insulin. Perhaps surprisingly, the most common complications of diabetic ketoacidosis are related to this lifesaving treatment.
Exams and Tests. Ketone testing is usually done when DKA is suspected: Most often, urine testing is done first. If the urine is positive for ketones, most often a ketone called beta-hydroxybutyrate is measured in the blood. This is the most common ketone measured. The other main ketone is acetoacetate. Other tests for ketoacidosis include: Arterial blood gas Basic metabolic panel , a group of blood tests that measure your sodium and potassium levels, kidney function, and other chemicals and functions, including the anion gap Blood glucose test Blood pressure measurement Osmolality blood test.
Outlook Prognosis. Most people respond to treatment within 24 hours. Sometimes, it takes longer to recover. If DKA is not treated, it can lead to severe illness or death. Possible Complications. Health problems that may result from DKA include any of the following: Fluid buildup in the brain cerebral edema Heart stops working cardiac arrest Kidney failure.
When to Contact a Medical Professional. DKA is often a medical emergency. Call your provider if you notice symptoms of DKA. Go to the emergency room or call the local emergency number such as if you or a family member with diabetes has any of the following: Decreased consciousness Fruity breath Nausea and vomiting Trouble breathing.
However, because phosphate deficiency is linked with muscle fatigue, rhabdomyolysis, hemolysis, respiratory failure, and cardiac arrhythmia, replacement is recommended when the phosphate level falls below 1. This can be achieved by adding 20 to 30 mEq of potassium phosphate to the intravenous fluid. DKA can cause a drop in magnesium, which can result in paresthesia, tremor, muscle spasm, seizures, and cardiac arrhythmia.
It should be replaced if it falls below 1. Cerebral edema is the most severe complication of DKA. It occurs in 0. Other complications of DKA include hypokalemia, hypoglycemia, acute renal failure, and shock. Less common problems can include rhabdomyolysis, 41 thrombosis and stroke, 42 pneumomediastinum, 43 prolonged corrected QT interval, 44 pulmonary edema, 45 and memory loss with decreased cognitive function in children.
Physicians should recognize signs of diabetes in all age groups, and should educate patients and caregivers on how to recognize them as well eTable A. In one study, persons with DKA had symptoms of diabetes for This includes more frequent glucose monitoring; continuing insulin, but at lower doses, during times of decreased food intake; and checking urine ketone levels with a dipstick test if the glucose level is greater than mg per dL Education for physicians on early recognition of diabetes mellitus symptoms for prompt diagnosis A1.
Group visits A2. Referral for diabetes education with certified educator or pharmacist A3, A4. Telecommunication A5. Early contact with clinician. Insulin reduction rather than elimination.
Measurement of urine or serum ketone level. Psychological counseling for those who eliminate insulin for body image concerns, and those who have major depression or other psychological illnesses that interfere with proper management. Assess reasons for discontinuation of insulin e. Referral to community resources. Effectiveness of a prevention program for diabetic ketoacidosis in children. An 8-year study in schools and private practices. Group visits in diabetes care: a systematic review.
Diabetes Educ. National standards for diabetes self-management education. Pharmacist-led group medical appointment model in type 2 diabetes.
New direction for enhancing quality in diabetes care: utilizing telecommunications and paraprofessional outreach workers backed by an expert medical team.
Telemed J E Health. A Web-based interprofessional diabetes education course. Am J Pharm Educ. Sick day management in children and adolescents with diabetes.
Pediatr Diabetes. Prescription co-pay reduction program for diabetic employees. Popul Health Manag. Nonadherence to medical regimens is often the cause of recurrent DKA. Physicians need to recognize patient barriers to getting care, such as financial, social, psychological, and cultural reasons. Diabetes education with certified educators and pharmacists enhances patient care. Data Sources: In July , an initially broad search of PubMed, Essential Evidence Plus, and sources such as the Cochrane database and Clinical Evidence was conducted using the key term diabetic ketoacidosis.
In the fall of , another search was conducted using additional key terms, such as incidence and prevalence.
As information was collected, individual questions were then searched to add finer points to the documentation. The searches were repeated with each draft of the manuscript. Already a member or subscriber? Log in. Interested in AAFP membership? Learn more. Address correspondence to Dyanne P. Reprints are not available from the author. Diabetic ketoacidosis in Denmark incidence and mortality estimated from public health registries. Diabetes Res Clin Pract. Predictors of diabetic ketoacidosis in children and adolescents with type 1 diabetes.
Experience from a large multicentre database. Declining death rates from hyperglycemic crisis among adults with diabetes, U. Diabetic ketoacidosis at diagnosis in Austrian children in — a population-based analysis.
Westphal SA. The occurrence of diabetic ketoacidosis in non-insulin-dependent diabetes and newly diagnosed diabetic adults. Am J Med. Clinical characteristics of Korean patients with new-onset diabetes presenting with diabetic ketoacidosis.
Syndromes of ketosis-prone diabetes mellitus. Endocr Rev. Narrative review: ketosis-prone type 2 diabetes mellitus. New-onset diabetes and ketoacidosis with atypical antipsychotics. Schizophr Res. Olanzapine-induced diabetic ketoacidosis. Ann Pharmacother. Risperidone-associated transient diabetic ketoacidosis and diabetes mellitus type 1 in a patient treated with valproate and lithium.
Active use of cocaine: an independent risk factor for recurrent diabetic ketoacidosis in a city hospital. Endocr Pract. Trachtenbarg DE. Am Fam Physician. Yan L. Wilson JF. Diabetic ketoacidosis Ann Intern Med. Clinical features at the onset of childhood type 1 diabetes mellitus in Shenyang, China. J Paediatr Child Health. Association of diabetic ketoacidosis and acute pancreatitis: observations in consecutive episodes of DKA. Am J Gastroenterol. Kelly AM. The case for venous rather than arterial blood gases in diabetic ketoacidosis.
Emerg Med Australas. Normoglycemic diabetic ketoacidosis in pregnancy. J Perinatol. Diabetic ketoacidosis in pregnancy tends to occur at lower blood glucose levels: case-control study and a case report of euglycemic diabetic ketoacidosis in pregnancy. J Obstet Gynaecol Res. Point of care blood ketone testing of diabetic patients in the emergency department.
If your health care provider has not told you what levels of ketones are dangerous, then call when you find moderate amounts after more than one test. Often, your health care provider can tell you what to do over the phone. Do NOT exercise when your urine tests show ketones and your blood glucose is high. High levels of ketones and high blood glucose levels can mean your diabetes is out of control.
Check with your health care provider about how to handle this situation. Log in menu Manage Account Search. Donate now. Diabetes Complications.
What are the warning signs of DKA? Early symptoms include the following: Thirst or a very dry mouth Frequent urination High blood glucose blood sugar levels High levels of ketones in the urine Then, other symptoms appear: Constantly feeling tired Dry or flushed skin Nausea, vomiting, or abdominal pain Vomiting can be caused by many illnesses, not just ketoacidosis.
If vomiting continues for more than 2 hours, contact your health care provider. Difficulty breathing Fruity odor on breath A hard time paying attention, or confusion Warning!
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