Last updated on: February 9th, 2021

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Diabetic ketoacidosis

Clinicals - History


Diabetic ketoacidosis (DKA) is an acute, life-threatening metabolic disturbance, characterized by hyperglycemia, metabolic acidosis, and ketonemia. It is the result of relative or absolute insulin deficiency, accompanied by an excess of counter-regulatory hormones including glucagon, cortisol, catecholamines and growth hormones.

Gastrointestinal symptoms

Nausea and vomiting are the most common symptoms of DKA. DKA can also manifest with non-specific abdominal pain and ileus, sometimes mimicking an acute abdomen. This is thought to be caused by hypovolemia-induced mesenteric ischemia and delayed emptying.

Decreased level of consciousness

Lethargy, somnolence, or stupor is present in half of cases of DKA. This is due to intracellular glucose starvation and the inability to convert ingested food into energy. Patients with severe DKA can present with loss of consciousness.

Polydipsia, polyphagia, and polyuria

Many patients will have undiagnosed diabetes mellitus, which is characterized by the classic triad of hyperglycemic symptoms: polyphagia, polyuria and polydipsia.

Insulin deficiency drives tissue catabolism, which keeps the satiety center of the brain activated. This increases appetite and food intake resulting in polyphagia. Persistent hyperglycemia causes osmotic diuresis resulting in polyuria. This depletes total water reserves in the body, which induces thirst and wanting to drink, leading to polydipsia.

Precipitating factors

Unless it is the initial presentation of diabetes mellitus, DKA rarely occurs without a precipitating event. Specific symptoms and signs will reflect the underlying illness, e.g., infection, ischemia, surgery, pregnancy, eating disorders, or carbohydrate metabolism-altering drugs.

History of diabetes

Many patients with DKA have a history of type 1 diabetes mellitus. In such cases, the most common precipitating condition is omission of insulin, which may result from non-adherence to insulin therapy or insulin pump failure.

Note however that about one-third of patients with DKA have newly diagnosed diabetes. This is especially true in young children.

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