by Nicole Evans M.D.

Created on: April 26, 2009

Diabetic ketoacidosis is a serious complication that can occur in individuals with Type 1 Diabetes Mellitus. The main physiologic features of diabetic ketoacidosis, or "DKA", include:

-High levels of glucose in the blood and urine

-High levels of ketone bodies in the blood and urine

-Low body pH level (acidosis)

-Dehydration

In Type 1 Diabetes, the insulin producing cells of the pancreas are destroyed by an autoimmune process. Insulin is a hormone that allows the main energy fuel of the body, glucose, to enter muscle, fat and liver cells so that those cells may utilize the glucose. When glucose can't get inside cells a condition called hyperglycemia (high blood glucose) ensues.

However, these muscle, fat and liver cells still need a source of fuel. Hormones such as glucagon, growth hormone, and catecholamines begin to enhance the breakdown of stored fat into free fatty acids and also stimulate gluconeogenesis (the production of glucose).

Metabolism of these high levels of free fatty acids by a process called beta-oxidation leads to increased formation of ketone bodies. Ketones, in turn, use up the extracellular and intracellular acid buffers so that the body becomes increasingly acidotic.

As the pH of the body drops, respiratory compensation is initiated. An individual in diabetic ketoacidosis (DKA) will take deep, rapid breaths. This type of breathing allows them to release increased amounts of carbon dioxide (an acid) from the body with each breath.

The body tries to compensate for the high blood glucose levels by releasing glucose in the urine. Water follows glucose, so the higher the glucose, the more a person urinates and the more water is lost. Thus, an individual with DKA is often profoundly dehydrated.

Additionally, potassium has difficulty getting into cells at an acidic pH. In this situation, the potassium levels in the blood may appear high and so potassium will be released in the urine. This causes the overall body stores of potassium to drop. This is an important consideration because once the acidosis is corrected potassium from the blood will be able to re-enter cells and may create a dangerous state of hypokalemia (low blood potassium).

These processes manifest as the following signs and symptoms:
Thirst
Frequent urination
Night time urination
Generalized weakness
Malaise/lethargy
Nausea/vomiting
Decreased perspiration
Fatigue
Anorexia or increased appetite
Confusion
Ill appearance
Dry skin
Labored breathing
Ketotic breath (fruity, with acetone smell)
Dry mucous membranes
Abdominal tenderness

DKA can be life-threatening and requires urgent medical attention. If you suspect DKA in yourself or another individual take them to the emergency room or call 911 immediately.

Learn more about this author, Nicole Evans M.D..
Click here to send this author comments or questions.