Diabetes Ketoacidosis Treatment in Delhi, India

Diabetic ketoacidosis (DKA) can be a life-threatening complication of diabetes mellitus, and it can occur when the body has a severe insulin deficiency. Insulin helps regulate blood sugar levels by allowing glucose to enter cells for energy. When there is not enough insulin, the body begins breaking down fat for energy, producing ketones. Ketones are acidic chemicals that build up in the blood, leading to acidosis. DKA is an emergency and requires prompt treatment to prevent serious complications or death.

Speciality

Endocrinology, Internal Medicine, Emergency Medicine

Associated Anatomy

DKA can affect multiple organs and systems in the body, including the pancreas, liver, kidneys, brain, and cardiovascular system.

Types of Diabetic Ketoacidosis

There are two main types of diabetic ketoacidosis:

Diabetic ketoacidosis in Type 1 Diabetes Mellitus: Seen among individuals with type 1 diabetes, it occurs when there is a complete or near-complete absence of insulin in the body, leading to a higher production of ketones by the liver. Type 1 diabetes-related DKA can occur due to missed insulin doses, illness, infection, or other stressors that increase the demand for insulin.

Diabetic ketoacidosis in Type 2 Diabetes Mellitus: This type of DKA is usually seen in those with chronic and poorly controlled diabetes. It can occur due to insulin deficiency or resistance, which may lead to an increase in blood glucose levels and ketone production. Type 2 diabetes-related DKA is usually triggered by infection, illness, or stress.

Euglycemic diabetic ketoacidosis: A rare type of DKA that occurs in people with normal or near-normal blood sugar levels. The incidence of this type has increased with the use of SGLT2 inhibitors in insulinopenic patients.

Other types of ketoacidosis: There are several other types that can occur in individuals with specific medical conditions. These include alcoholic ketoacidosis, which can occur in chronic alcoholics with reduced insulin levels and increased ketone production, and starvation ketoacidosis, which can occur in individuals who are fasting or have a reduced caloric intake.

Symptoms of Diabetic Ketoacidosis

Symptoms of DKA can develop rapidly over a few hours or days and may include:

• Excessive thirst and urination
• Abdominal pain
• Nausea and vomiting
• Fatigue and weakness
• Shortness of breath
• Fruity-smelling breath
• Confusion or difficulty concentrating
• Rapid heartbeat
• Low blood pressure

Causes of Diabetic Ketoacidosis

One of the most common causes of ketoacidosis is uncontrolled diabetes, specifically type 1 diabetes. It can also occur in those with type 2 diabetes combined with insulin deficiency or during periods of stress, infection, or other illnesses which lead to relative insulin deficiency. DKA is also commonly caused by a lack of insulin in the body, which can occur due to various factors, including:

• Untreated or uncontrolled diabetes
• Infection or illness
• Injury or surgery
• Certain medications
• Pregnancy

Risk factors of Diabetic Ketoacidosis (DKA)

Risk factors for DKA include:

• Having type 1 diabetes or uncontrolled type 2 diabetes
• Not following a diabetes treatment plan
• Illness or infection
• Pregnancy
• Substance abuse, particularly with drugs like cocaine or ecstasy.

Stages of Diabetic Ketoacidosis (DKA)

DKA typically progresses in stages:

Stage 1: Mild to moderate dehydration, increased ketone levels, and mild acidosis.

Stage 2: Severe dehydration, high ketone levels, and moderate acidosis.

Stage 3: Severe dehydration, very high ketone levels, and severe acidosis.

Diagnosis of Diabetic Ketoacidosis (DKA)

The diagnosis of DKA is based on symptoms, blood tests to measure glucose and ketone levels, and sometimes imaging tests to check for complications. Tests like chest x-rays and urinalysis may also be recommended.

Treatment of Diabetic Ketoacidosis (DKA)

Treatment for DKA typically involves hospitalization and may include:

• Administration of fluids and electrolytes to rehydrate the body and restore normal blood sugar and pH levels.
• Insulin therapy to lower blood sugar and stop ketone production.
• Treatment of any underlying conditions, such as infections or injuries.
• Monitoring for complications, such as kidney or heart failure.

Complications of Diabetic Ketoacidosis (DKA)

• Complications of DKA may include:
• Brain swelling (cerebral oedema)
• Kidney failure
• Abnormal heart rhythms
• Respiratory failure
• Death

Prevention of Diabetic Ketoacidosis (DKA)

Prevention of DKA involves properly managing diabetes through a healthy diet, regular exercise, and taking insulin or other medications as prescribed. 

Monitoring blood sugar levels regularly and seeking prompt medical attention if symptoms of DKA develop is crucial.

Prognosis of Diabetic Ketoacidosis (DKA)

With prompt and appropriate treatment, most people with DKA recover fully and have a good prognosis. However, if left untreated, the condition can be life-threatening, and some people may experience long-term complications.

FAQs About Diabetic Ketoacidosis (DKA)

What are some warning signs of diabetic ketoacidosis?

Warning signs of diabetic ketoacidosis may include excessive thirst, frequent urination, high blood sugar levels, fruity-smelling breath, nausea and vomiting, abdominal pain, weakness or fatigue, confusion, and shortness of breath.

What IV fluids are given for DKA?

The IV fluids given for DKA typically include isotonic saline to correct dehydration and maintain blood pressure and potassium chloride to replace electrolytes lost through excessive urination. In some cases, other electrolyte solutions may also be given.

How is diabetic ketoacidosis treated in an emergency?

Diabetic ketoacidosis is a medical emergency that requires immediate treatment. The standard treatment involves administering intravenous fluids, insulin, and electrolytes to correct dehydration, lower blood glucose levels, and restore electrolyte balance. Oxygen therapy and other supportive measures may also be needed.

How long can ketoacidosis last?

The duration of ketoacidosis depends on its severity and how quickly it is treated. Symptoms may sometimes resolve within a few hours or days of treatment. However, severe cases of ketoacidosis can take several days or longer to resolve and may require hospitalization.

Review

Reviewed by Dr Saket Kant, Senior Consultant - Endocrinology & Diabetes on 5 June 2024.