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Diabetic ketoacidosis is a severe complication

Author: Dr Sorin Ioacara, MD, PhD
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Discover here: Incidence | Symptoms of ketoacidosis

Diabetic ketoacidosis is a severe acute complication of type 1 diabetes. Sometimes it can also occur in type 2 diabetes with a high insulin deficiency and a major precipitating factor (e.g. a severe viral or bacterial infection).

Ketoacidosis is mostly a significant defect in lipid metabolism. Decreasing insulin availability below a certain critical threshold will unlock an accessory pathway for fatty acid metabolism in the liver. It is about their transformation into ketone bodies. The accumulation of ketone bodies eventually leads to diabetic ketoacidosis.

Frequency of diabetic ketoacidosis

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Type 1 diabetes begins in more than 50% of cases with ketoacidosis. The percentage rises to 70% for children or patients with slightly lower access to education or medical care. The infant and child up to three years of age almost always have a degree of ketoacidosis at onset. After the clinical diabetes onset, the risk of developing diabetic ketoacidosis decreases significantly. However, in stages 3 and 4 of type 1 diabetes, the risk of diabetic ketoacidosis is never absent for anyone.

Every year, if we follow 1000 patients with type 1 diabetes, we will find the appearance of approximately 50 episodes of ketoacidosis. These episodes occur in about 30 patients.

The explanation is that some patients have repeated episodes of ketoacidosis in one year. Further, diabetic ketoacidosis tends to occur primarily in patients who have had such events in the past.

The top ten risk factors for diabetic ketoacidosis are:

  1. Complete or partial discontinuation of insulin therapy
  2. The onset of type 1 diabetes
  3. Food poisoning with diarrhoea and vomiting
  4. Any significant viral or bacterial infection
  5. Insufficiently supervised child
  6. Adolescence, especially in girls
  7. Alcohol intoxication
  8. Major cardiovascular events (e.g. myocardial infarction)
  9. Lack of access to continuous blood glucose monitoring sensors
  10. Lack of access to insulin pumps with the possibility of “close-loop”

Symptoms of diabetic ketoacidosis

An elephant with dry skin passes by a small, almost dry water

The symptoms of diabetic ketoacidosis appear gradually over several hours. Their evolution depends very much on the way the patient is hydrated. The use of sweet juices at the onset of type 1 diabetes quickly aggravates the situation. At the same time, however, intense hydration with water can slow down the rate of ketoacidosis. In this way, it is possible to intervene therapeutically at home and thus avoid hospitalization.

The main symptoms of diabetic ketoacidosis are:

  1. Dehydration
  2. Increased heart rate
  3. Lack of air
  4. Nausea and vomiting
  5. Abdominal pain
  6. Confusion, drowsiness
  7. Loss of consciousness, coma

Dehydration and increased heart rate

The main symptom of diabetic ketoacidosis is dehydration. The mouth and lips are dry. The tongue becomes loaded with whitish secretions. The fold of the skin on the abdomen persists a little longer when you release it.

The affected patient feels fatigue that does not go away through rest. The dehydrated child does not feel like playing and runs less. Severe dehydration in the child may be associated with tear-free crying from sunken eyes.

The second prominent symptom is increased heart rate (tachycardia). The heart beats faster to maintain the required blood flow when its total volume has decreased. The pulse is often over 100 beats per minute.

Shortness of breath, nausea and vomiting

As the severity of ketoacidosis increases, so will the lack of air. The patient takes a deep breath and breathes more often than usual. When the patient with diabetic ketoacidosis is lying on his back, you can see a broad range of movements of the sternum and rib cage with each breath.

This type of breathing has been called Kussmaul breathing. The exhaled air has a slight odour of acetone or green apples.

Nausea and vomiting are alarming symptoms of the need for hospitalization to resolve diabetic ketoacidosis. Loss of fluid and minerals from vomiting will exacerbate the patient’s dehydration. Anti vomiting medication does not affect the nausea. They don’t work whether administered orally or intravenously.

Abdominal pain, confusion, drowsiness and coma

Diffuse pain may appear in the abdominal wall, which accentuates when pressing the belly. This creates the impression of a medical problem of the digestive tract.

In the past, appendicitis operations were sometimes unnecessarily performed as a result of a false “surgical abdomen”. This “stomach” pain does not wean following the administration of antacids or “ulcer” drugs.

Moderate ketoacidosis can interfere with the patient’s rational thinking. The answers come harder in a conversation, and the sentences tend to be shorter. The onset of extreme fatigue with marked drowsiness indicates severe diabetic ketoacidosis.

The patient who has lost consciousness is in a critical, life-threatening situation. He must be transported to the hospital as soon as possible to save his life.

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