Diabetic ketoacidosis

Diabetic ketoacidosis (DKA) is a serious complications of untreated diabetes. In this complication, severely insufficient insulin levels in the body results into high blood sugar that leads to the production and buildup of ketones in the blood. These ketones are slightly acidic, and large amounts of them can lead to ketoacidosis. If remained untreated, the condition leads to diabetic coma and may be fatal. Diabetic ketoacidosis (DKA) gets triggered by a stressful event on the body, such as an illness or severe lack of insulin.

DKA is more common in people with type 1 diabetes. In some cases, identification of DKA is the first indication that a person has diabetes.

Signs & Symptoms

 * Early


 * Sluggish and extreme tiredness
 * Fruity smell to breath (like acetone)
 * Extreme thirst, despite large fluid intake
 * Constant urination/bedwetting
 * Extreme weight loss
 * Presence of Oral Thrush or yeast infections that fail to go away
 * Muscle wasting
 * Agitation / Irritation / Aggression / Confusion


 * Late

At this stage, Diabetic ketoacidosis reaches a life-threatening level:


 * Vomiting. Although this can be a sign of hyperglycemia and isn't always a late-stage sign, it can occur with or without ketoacidosis.
 * Confusion
 * Abdominal pain
 * Loss of appetite
 * Flu-like symptoms
 * Unconsciousness (diabetic coma)
 * Being lethargic and apathetic
 * Extreme weakness
 * Kussmaul breathing (air hunger). In this condition, patients breathe more deeply and/or more rapidly

Risk factors
The major risk factors accelerating on set of diabetic ketoacidosis include the following:


 * Diabetes mellitus: Type 1 diabetics are at a higher risk of DKA, because they must rely on outside insulin sources for survival. DKA can occur in patients with type 2, particularly in obese children.
 * Age: DKA may occur at any age, but younger people below 19 years of age are more susceptible.
 * Rapid-acting insulin devices: Patients with diabetes who manage their blood glucose levels with rapid-acting insulin (such as through an insulin pump) instead of a combination of rapid-acting and long-acting insulin are at a higher risk of DKA.

Causes
Around 10 percent of persons with diabetes don't have any specific and identifiable cause for developing diabetic ketoacidosis, though occurrence of this condition is prevalent in persons with diabetes.

People with type 1 diabetes do not secrete the hormone insulin, which is required in order to fully metabolize glucose and allow it into the body's cells. Because glucose cannot be used as a source of energy, the body relies on burning fat for fuel. The metabolization of fat produces ketones, slightly acidic molecules such as  acetoacetic acid and acetone. A buildup of ketones can cause the blood to become acidic, which can be fatal if not treated immediately.

Further, events which are stressful can also result into diabetic ketoacidosis - stress prompts and accelerates the release of excessive amounts of hormones that break down fat into glucose. Excessive amounts of these hormones negatively impacts the ability of insulin to assist smoothly the uptake of glucose into the cells. The combination of all these factors result into diabetic ketoacidosis.

Many times, daiabetic ketoacidosis (DKA) also gets triggered by infections. Inadequate or improper insulin therapy also triggers DKA. Other causes of DKA include:


 * Insufficient intake of fluid, particularly during hot weather,
 * Heart attack and/or stroke,
 * Alcohol and/ or drug abuse,
 * Pancreatitis, that is, an inflammation of the pancreas, and
 * Physical or emotional trauma.

Prevention

 * Monitoring blood sugar and ketone levels: Regular monitoring blood sugar and ketone levels are essential steps to prevent development of diabetic ketoacidosis. This is more important during any sort of infection, trauma, excessive stress due to any reason. Such a monitoring is also essential by pregnant women with diabetes. If blood glucose levels consistently exceed 300mg/dL, medical consultation is necessary.


 * Assessing and evaluation of diabetic condition: This is also a necessary part of any prevention program. Diabetic ketoacidosis may arise on account of irregular or insufficient insulin treatment. In order to rectify the situation, suitable alteration may be required, in consultation with medical care personnel, to alter the insulin treatment to give better results.


 * Prompt and proper medical consultation: Any unusual signs and symptoms such as vomiting, confusion, elevated blood sugar levels, stomach pain, etc. indicate that medical consultation is urgently required. Diabetic ketoacidosis may turn fatal if remaining untreated.

Complications
Persons with diabetic ketoacidosis (DKA) require very frequent monitoring to watch the complications. Most of the complications of DKA are related to its treatment which pose a rather difficult position to control the complications. The three major complications of diabetic ketoacidosis are:


 * Hypoglycemia: Hypoglycemia indicates blood sugar level that is below the normal lows. With insulin treatment, cells become active and picks up the sugar fast that causes the blood sugar level to drop rapidly. Any quick drop of blood sugar results into hypoglycemia.


 * Hypokalemia: Hypokalemia indicates a very low level of the electrolyte potassium in the blood. Insulin treatment infuses sufficient insulin in the blood at one stroke, insulin and fluids help in the entry of potassium into the cells, which decreases and depletes the level of potassium in the blood. Continuously low level of potassium in blood can impari muscle, activities of nerve, and can also impair heart.


 * Cerebral edema: It is a rare complication of diabetic ketoacidosis. In cerebral edema, brain swelling takes place on account of buildup of fluid in the brain cells. A rare complication, cerebral edema is brain swelling caused by a buildup of fluid in the brain cells. It's not certain why treatment causes cerebral edema to develop, although it may be related to rapid fluid replacement. Cerebral edema most frequently occurs in children.

Treatment
DKA - Diabetic ketoacidosis requires urgent treatment immediately after it is diagnosed. Treatment involves fluid replacement, electrolyte replacement, and intravenous insulin therapy. After initial treatment, the health care personnel tries to understand the exact reason that caused the DKA to plan further course of action - for instance, if it was triggered by heart attack, further evaluation of heart condition is done or if it was triggered by infection, the nature of infection is examined and antibiotics may be prescribed.