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Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes. However, mortality rates are fairly low
Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes that is most commonly seen among people with type I diabetes, although people with type II diabetes can also develop DKA.
With appropriate and timely treatment, the survival rate of DKA is quite high at over 95%. Survival rates are poorer in the elderly and those with known organ damage.
What is the mortality rate for diabetic ketoacidosis?
Mortality rates of diabetic ketoacidosis (DKA) are as follows:
- Overall: 0.2%-2%
- Individuals under 40: 5%
- Elderly or those with serious illnesses: 20%
What causes diabetic ketoacidosis?
Diabetic ketoacidosis (DKA) can develop when there is an imbalance in the body causing high blood sugar and low insulin levels that leads to an overload of ketones (a blood acid) due to the rapid breakdown of fats by the liver.
- DKA is a result of severely decreased insulin levels that do not allow blood sugar into the cells to be used up for energy.
- Normally, insulin plays a key role in helping sugar (a major energy source for the muscles and other tissues) enter the cells.
- Without enough insulin, fats are broken down rapidly in the liver, which produces ketones that make the blood acidic.
- When ketones accumulate in the blood, they can become toxic and lead to ketoacidosis.
Other causes of DKA include:
- Serious illnesses such as heart attack, stroke, or pancreatitis
- Infections
- Misses doses of insulin shots
- Physical injury or trauma
- Stress of surgery
- Alcohol or drug use
- Heat stroke
- Certain medications such as diuretics and corticosteroids
People with type II diabetes can also develop DKA, but it is less common and less severe.
What are risk factors for diabetic ketoacidosis?
Risk factors for diabetic ketoacidosis include:
- Type I diabetes (even if it is undiagnosed)
- Frequent missed insulin doses
- Not taking insulin as prescribed
- Gastrointestinal diseases
- Infections
- Heart diseases or a heart attack
- Recent stroke
- Blood clots in the lungs
- Serious illness or any trauma
- Pregnancy
- Surgery
- Medicines such as steroids or antipsychotics
- Using illegal drugs such as cocaine
How is diabetic ketoacidosis diagnosed?
If diabetic ketoacidosis (DKA) is suspected, a physical examination and certain tests can help confirm a diagnosis. In some cases, additional tests may be needed to help determine the triggering factor of DKA:
- Blood tests to measure:
- Sugar levels
- Ketone levels
- Electrolytes
- Acidity
- Osmolality
- Arterial blood gas
- Urinalysis
- X-ray chest
- Electrocardiogram
A confirmed diagnosis of DKA is generally made if:
- Blood glucose level is higher than 250 mg/dL
- Blood pH is less than 7.3 (acidosis)
- There is presence of ketones in the urine and/or blood
- Serum bicarbonate level is lower than 18 mEq/L
How is diabetic ketoacidosis treated?
If a person is diagnosed with diabetic ketoacidosis (DKA), emergency treatment is required and will likely include:
- Fluid replacement: Replacing fluids lost through frequent urination to help dilute excess sugar in the blood
- Electrolyte replacement: Replacing electrolytes such as sodium, potassium, and chloride, which helps the nerves, muscles, heart, and brain function properly
- Insulin therapy: Reverses the triggers that cause DKA by impairing cell physiology
- Medicines for underlying conditions: May include antibiotics for an infection
What are potential complications of diabetic ketoacidosis?
Potential complications of diabetic ketoacidosis (DKA) include:
- Hypoglycemia (low blood sugar levels)
- Hypokalemia (low blood potassium levels)
- Cerebral edema (swelling in the brain)
- Pulmonary edema (fluid inside of the lungs)
- Damage to the kidneys and other organs
If left untreated, DKA can lead to loss of consciousness and death.