{"id":5122,"date":"2025-11-26T23:53:50","date_gmt":"2025-11-27T04:53:50","guid":{"rendered":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/?post_type=chapter&p=5122"},"modified":"2025-12-07T23:09:04","modified_gmt":"2025-12-08T04:09:04","slug":"diabetic-ketoacidosis-dka","status":"web-only","type":"chapter","link":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/chapter\/diabetic-ketoacidosis-dka\/","title":{"raw":"9p13 Diabetic Ketoacidosis (DKA) - Acute Complication of Diabetes Mellitus","rendered":"9p13 Diabetic Ketoacidosis (DKA) – Acute Complication of Diabetes Mellitus"},"content":{"raw":"Diabetic Ketoacidosis (DKA) \u2013 Possible Acute Complication of Diabetes Mellitus<\/strong>\r\n

Overview<\/strong><\/h1>\r\n
    \r\n \t
  • More common in\u00a0Type 1 diabetes<\/strong>.<\/li>\r\n \t
  • Results from\u00a0prolonged insulin deficiency<\/strong>.<\/li>\r\n \t
  • Can occur if insulin injections are missed,<\/strong> or during times of insulin deficiency<\/strong>, when cells are requiring more glucose, which may occur during times of stress<\/strong>,\u00a0infection<\/strong>, or\u00a0excessive exercise<\/strong>.<\/li>\r\n<\/ul>\r\n

    Causes of DKA<\/strong><\/h1>\r\n
      \r\n \t
    • Missed insulin doses<\/strong>.<\/li>\r\n \t
    • Prolonged exercise<\/strong>\u00a0without insulin.<\/li>\r\n \t
    • Overeating<\/strong>\u00a0or high carbohydrate intake, especially if insulin is unavailable.<\/li>\r\n \t
    • Stressors<\/strong>\u00a0like infection or illness increase fat breakdown and ketone production.<\/li>\r\n<\/ul>\r\n

      Pathophysiology<\/strong><\/h1>\r\n
        \r\n \t
      • Lack of insulin<\/strong>\u00a0prevents glucose from entering cells via\u00a0GLUT4<\/strong>\u00a0channels.<\/li>\r\n \t
      • Blood glucose<\/strong>\u00a0levels rise (hyperglycemia<\/strong>).<\/li>\r\n \t
      • Cells\u00a0starve for glucose<\/strong>, leading to\u00a0reduced ATP production \u2192 reduced cellular function.<\/strong>\r\n
          \r\n \t
        • results in increased catabolism of fat and protein to produce ATP<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n
            \r\n \t
          • Muscle cells and other tissues break down fats<\/strong>\u00a0(lipolysis) producing\u00a0ketones<\/strong>.<\/li>\r\n \t
          • Ketones<\/strong>\u00a0are acidic wastes (e.g.,\u00a0beta-hydroxybutyric acid<\/strong>,\u00a0acetoacetic acid<\/strong>,\u00a0acetone<\/strong>).\r\n
              \r\n \t
            • Acetone (fruity smell on breath)<\/li>\r\n<\/ul>\r\n<\/li>\r\n \t
            • Excess ketones build up in the blood (ketonemia),<\/strong> leading to blood acidosis (ketoacidosis)<\/strong>.<\/li>\r\n<\/ul>\r\n
                \r\n \t
              • Ketones<\/strong>\u00a0accumulate and\u00a0bind serum bicarbonate<\/strong>, reducing the blood's buffering capacity.<\/li>\r\n \t
              • Blood\u00a0pH drops below pH 7.3<\/strong>\u00a0(acidic blood).<\/li>\r\n \t
              • High ketone levels cause\u00a0toxicity<\/strong>, impairing enzyme functions.<\/li>\r\n<\/ul>\r\n

                Progression of DKA<\/strong><\/h1>\r\n
                  \r\n \t
                • Water loss from osmotic diuresis due to, polyuria, glucosuria<\/strong> and ketonuria<\/strong> causes dehydration<\/strong>.<\/li>\r\n \t
                • Electrolyte imbalance<\/strong>\u00a0(potassium, sodium).<\/li>\r\n \t
                • Decreased renal function<\/strong> leads to oliguria and less ketone excretion<\/strong>.<\/li>\r\n \t
                • Accumulation causes\u00a0decompensated metabolic acidosis<\/strong>\u00a0and\u00a0potential coma<\/strong>.<\/li>\r\n<\/ul>\r\n

                  Signs and Symptoms<\/strong><\/h1>\r\n
                    \r\n \t
                  • Rapid breathing<\/strong> (Kussmaul respiration) to compensate for acidosis<\/strong>\r\n
                      \r\n \t
                    • breathing out CO2<\/sub> reduces carbonic acid in blood.<\/li>\r\n<\/ul>\r\n<\/li>\r\n \t
                    • Fruity smell<\/strong>\u00a0on the breath (acetone).<\/li>\r\n \t
                    • Nausea, vomiting<\/strong>, abdominal pain<\/li>\r\n \t
                    • Frequent urination (polyuria)<\/strong> initially, followed by oliguria<\/strong><\/li>\r\n \t
                    • Dehydration<\/strong>\u00a0signs:\r\n
                        \r\n \t
                      • Dry mouth<\/strong> and mucous membranes<\/li>\r\n \t
                      • Thirst<\/strong> (polydipsia)<\/li>\r\n \t
                      • Low blood pressure<\/strong><\/li>\r\n \t
                      • Thready, rapid pulse and\/or tachycardia<\/li>\r\n \t
                      • Confusion, headache,<\/strong> and weakness<\/strong><\/li>\r\n \t
                      • Can lead to coma<\/strong> and be life-threatening.<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n

                        Urinalysis<\/strong><\/h1>\r\n
                          \r\n \t
                        • Ketonuria<\/strong>\u00a0(ketones in urine).<\/li>\r\n \t
                        • Glucosuria<\/strong>\u00a0(glucose in urine).<\/li>\r\n<\/ul>\r\n

                          Nervous System and Brain Effects<\/strong><\/h1>\r\n
                            \r\n \t
                          • Dehydration reduces\u00a0brain perfusion<\/strong>.<\/li>\r\n \t
                          • Electrolyte imbalances<\/strong>\u00a0impair neuron and muscle function.<\/li>\r\n \t
                          • Decreased responsiveness<\/strong>,\u00a0lethargy<\/strong>, and\u00a0risk of coma<\/strong>.<\/li>\r\n<\/ul>\r\n

                            Progression and Risks<\/strong><\/h1>\r\n
                              \r\n \t
                            • Water loss causes\u00a0decreased blood volume<\/strong>\u00a0(hypovolemia).<\/li>\r\n \t
                            • Reduced renal function limits acid excretion.<\/li>\r\n \t
                            • Blood pH drops further<\/strong>\u00a0\u2192\u00a0decompensated metabolic acidosis<\/strong>.<\/li>\r\n \t
                            • Fatal dehydration<\/strong>\u00a0and\u00a0brain edema<\/strong>\u00a0possible if untreated.<\/li>\r\n \t
                            • Loss of consciousness<\/strong>\u00a0and potentially\u00a0coma<\/strong>.<\/li>\r\n<\/ul>\r\n

                              Severe Consequences<\/strong><\/h1>\r\n
                                \r\n \t
                              • Cerebral edema<\/strong>\u00a0due to brain swelling.<\/li>\r\n \t
                              • Cardiac dysrhythmias<\/strong>\u00a0caused by electrolyte disturbances.<\/li>\r\n \t
                              • Low blood volume<\/strong>\u00a0reduces perfusion.<\/li>\r\n \t
                              • Increased intracranial pressure<\/strong>\u00a0can impair brain function.<\/li>\r\n \t
                              • Potential death<\/strong>\u00a0if untreated.<\/li>\r\n<\/ul>\r\n

                                Treatment<\/strong><\/h1>\r\n
                                  \r\n \t
                                • Administer insulin<\/strong>\u00a0to restore glucose uptake.<\/li>\r\n \t
                                • Hydrate<\/strong>\u00a0with IV fluids to replace water and electrolytes.<\/li>\r\n \t
                                • Correct acidosis<\/strong>\u00a0with bicarbonate.<\/li>\r\n \t
                                • Treat underlying cause<\/strong>\u00a0(infection, diet change).<\/li>\r\n \t
                                • Continuous monitoring is vital to prevent progression.<\/li>\r\n<\/ul>\r\n

                                  Prevention<\/strong><\/h1>\r\n
                                    \r\n \t
                                  • Blood glucose monitoring<\/strong> is essential to avoid both hypoglycemia and hyperglycemia.<\/li>\r\n<\/ul>\r\n

                                    Summary<\/strong><\/h1>\r\n
                                      \r\n \t
                                    • DKA is a\u00a0life-threatening emergency<\/strong>.<\/li>\r\n \t
                                    • Rapid recognition and intervention are crucial for survival.<\/li>\r\n \t
                                    • Proper treatment prevents severe dehydration, acidosis, and brain damage.<\/li>\r\n \t
                                    • Rapid recognition and treatment are critical:\r\n
                                        \r\n \t
                                      • Rehydrate<\/strong> with IV fluids.<\/li>\r\n \t
                                      • Correct electrolyte imbalances<\/strong>.<\/li>\r\n \t
                                      • Administer insulin<\/strong> to reduce blood glucose and ketones.<\/li>\r\n<\/ul>\r\n<\/li>\r\n \t
                                      • Wearing a\u00a0medical alert bracelet<\/strong>\u00a0is recommended for diabetics, especially those at risk for DKA.<\/li>\r\n<\/ul>","rendered":"

                                        Diabetic Ketoacidosis (DKA) \u2013 Possible Acute Complication of Diabetes Mellitus<\/strong><\/p>\n

                                        Overview<\/strong><\/h1>\n
                                          \n
                                        • More common in\u00a0Type 1 diabetes<\/strong>.<\/li>\n
                                        • Results from\u00a0prolonged insulin deficiency<\/strong>.<\/li>\n
                                        • Can occur if insulin injections are missed,<\/strong> or during times of insulin deficiency<\/strong>, when cells are requiring more glucose, which may occur during times of stress<\/strong>,\u00a0infection<\/strong>, or\u00a0excessive exercise<\/strong>.<\/li>\n<\/ul>\n

                                          Causes of DKA<\/strong><\/h1>\n
                                            \n
                                          • Missed insulin doses<\/strong>.<\/li>\n
                                          • Prolonged exercise<\/strong>\u00a0without insulin.<\/li>\n
                                          • Overeating<\/strong>\u00a0or high carbohydrate intake, especially if insulin is unavailable.<\/li>\n
                                          • Stressors<\/strong>\u00a0like infection or illness increase fat breakdown and ketone production.<\/li>\n<\/ul>\n

                                            Pathophysiology<\/strong><\/h1>\n
                                              \n
                                            • Lack of insulin<\/strong>\u00a0prevents glucose from entering cells via\u00a0GLUT4<\/strong>\u00a0channels.<\/li>\n
                                            • Blood glucose<\/strong>\u00a0levels rise (hyperglycemia<\/strong>).<\/li>\n
                                            • Cells\u00a0starve for glucose<\/strong>, leading to\u00a0reduced ATP production \u2192 reduced cellular function.<\/strong>\n
                                                \n
                                              • results in increased catabolism of fat and protein to produce ATP<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n
                                                  \n
                                                • Muscle cells and other tissues break down fats<\/strong>\u00a0(lipolysis) producing\u00a0ketones<\/strong>.<\/li>\n
                                                • Ketones<\/strong>\u00a0are acidic wastes (e.g.,\u00a0beta-hydroxybutyric acid<\/strong>,\u00a0acetoacetic acid<\/strong>,\u00a0acetone<\/strong>).\n
                                                    \n
                                                  • Acetone (fruity smell on breath)<\/li>\n<\/ul>\n<\/li>\n
                                                  • Excess ketones build up in the blood (ketonemia),<\/strong> leading to blood acidosis (ketoacidosis)<\/strong>.<\/li>\n<\/ul>\n
                                                      \n
                                                    • Ketones<\/strong>\u00a0accumulate and\u00a0bind serum bicarbonate<\/strong>, reducing the blood’s buffering capacity.<\/li>\n
                                                    • Blood\u00a0pH drops below pH 7.3<\/strong>\u00a0(acidic blood).<\/li>\n
                                                    • High ketone levels cause\u00a0toxicity<\/strong>, impairing enzyme functions.<\/li>\n<\/ul>\n

                                                      Progression of DKA<\/strong><\/h1>\n
                                                        \n
                                                      • Water loss from osmotic diuresis due to, polyuria, glucosuria<\/strong> and ketonuria<\/strong> causes dehydration<\/strong>.<\/li>\n
                                                      • Electrolyte imbalance<\/strong>\u00a0(potassium, sodium).<\/li>\n
                                                      • Decreased renal function<\/strong> leads to oliguria and less ketone excretion<\/strong>.<\/li>\n
                                                      • Accumulation causes\u00a0decompensated metabolic acidosis<\/strong>\u00a0and\u00a0potential coma<\/strong>.<\/li>\n<\/ul>\n

                                                        Signs and Symptoms<\/strong><\/h1>\n
                                                          \n
                                                        • Rapid breathing<\/strong> (Kussmaul respiration) to compensate for acidosis<\/strong>\n
                                                            \n
                                                          • breathing out CO2<\/sub> reduces carbonic acid in blood.<\/li>\n<\/ul>\n<\/li>\n
                                                          • Fruity smell<\/strong>\u00a0on the breath (acetone).<\/li>\n
                                                          • Nausea, vomiting<\/strong>, abdominal pain<\/li>\n
                                                          • Frequent urination (polyuria)<\/strong> initially, followed by oliguria<\/strong><\/li>\n
                                                          • Dehydration<\/strong>\u00a0signs:\n
                                                              \n
                                                            • Dry mouth<\/strong> and mucous membranes<\/li>\n
                                                            • Thirst<\/strong> (polydipsia)<\/li>\n
                                                            • Low blood pressure<\/strong><\/li>\n
                                                            • Thready, rapid pulse and\/or tachycardia<\/li>\n
                                                            • Confusion, headache,<\/strong> and weakness<\/strong><\/li>\n
                                                            • Can lead to coma<\/strong> and be life-threatening.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n

                                                              Urinalysis<\/strong><\/h1>\n
                                                                \n
                                                              • Ketonuria<\/strong>\u00a0(ketones in urine).<\/li>\n
                                                              • Glucosuria<\/strong>\u00a0(glucose in urine).<\/li>\n<\/ul>\n

                                                                Nervous System and Brain Effects<\/strong><\/h1>\n
                                                                  \n
                                                                • Dehydration reduces\u00a0brain perfusion<\/strong>.<\/li>\n
                                                                • Electrolyte imbalances<\/strong>\u00a0impair neuron and muscle function.<\/li>\n
                                                                • Decreased responsiveness<\/strong>,\u00a0lethargy<\/strong>, and\u00a0risk of coma<\/strong>.<\/li>\n<\/ul>\n

                                                                  Progression and Risks<\/strong><\/h1>\n
                                                                    \n
                                                                  • Water loss causes\u00a0decreased blood volume<\/strong>\u00a0(hypovolemia).<\/li>\n
                                                                  • Reduced renal function limits acid excretion.<\/li>\n
                                                                  • Blood pH drops further<\/strong>\u00a0\u2192\u00a0decompensated metabolic acidosis<\/strong>.<\/li>\n
                                                                  • Fatal dehydration<\/strong>\u00a0and\u00a0brain edema<\/strong>\u00a0possible if untreated.<\/li>\n
                                                                  • Loss of consciousness<\/strong>\u00a0and potentially\u00a0coma<\/strong>.<\/li>\n<\/ul>\n

                                                                    Severe Consequences<\/strong><\/h1>\n
                                                                      \n
                                                                    • Cerebral edema<\/strong>\u00a0due to brain swelling.<\/li>\n
                                                                    • Cardiac dysrhythmias<\/strong>\u00a0caused by electrolyte disturbances.<\/li>\n
                                                                    • Low blood volume<\/strong>\u00a0reduces perfusion.<\/li>\n
                                                                    • Increased intracranial pressure<\/strong>\u00a0can impair brain function.<\/li>\n
                                                                    • Potential death<\/strong>\u00a0if untreated.<\/li>\n<\/ul>\n

                                                                      Treatment<\/strong><\/h1>\n
                                                                        \n
                                                                      • Administer insulin<\/strong>\u00a0to restore glucose uptake.<\/li>\n
                                                                      • Hydrate<\/strong>\u00a0with IV fluids to replace water and electrolytes.<\/li>\n
                                                                      • Correct acidosis<\/strong>\u00a0with bicarbonate.<\/li>\n
                                                                      • Treat underlying cause<\/strong>\u00a0(infection, diet change).<\/li>\n
                                                                      • Continuous monitoring is vital to prevent progression.<\/li>\n<\/ul>\n

                                                                        Prevention<\/strong><\/h1>\n
                                                                          \n
                                                                        • Blood glucose monitoring<\/strong> is essential to avoid both hypoglycemia and hyperglycemia.<\/li>\n<\/ul>\n

                                                                          Summary<\/strong><\/h1>\n
                                                                            \n
                                                                          • DKA is a\u00a0life-threatening emergency<\/strong>.<\/li>\n
                                                                          • Rapid recognition and intervention are crucial for survival.<\/li>\n
                                                                          • Proper treatment prevents severe dehydration, acidosis, and brain damage.<\/li>\n
                                                                          • Rapid recognition and treatment are critical:\n
                                                                              \n
                                                                            • Rehydrate<\/strong> with IV fluids.<\/li>\n
                                                                            • Correct electrolyte imbalances<\/strong>.<\/li>\n
                                                                            • Administer insulin<\/strong> to reduce blood glucose and ketones.<\/li>\n<\/ul>\n<\/li>\n
                                                                            • Wearing a\u00a0medical alert bracelet<\/strong>\u00a0is recommended for diabetics, especially those at risk for DKA.<\/li>\n<\/ul>\n","protected":false},"author":1370,"menu_order":19,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":["zoe-soon"],"pb_section_license":"cc-by-nc-sa"},"chapter-type":[],"contributor":[60],"license":[57],"class_list":["post-5122","chapter","type-chapter","status-web-only","hentry","contributor-zoe-soon","license-cc-by-nc-sa"],"part":63,"_links":{"self":[{"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/chapters\/5122","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/wp\/v2\/users\/1370"}],"version-history":[{"count":14,"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/chapters\/5122\/revisions"}],"predecessor-version":[{"id":5258,"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/chapters\/5122\/revisions\/5258"}],"part":[{"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/parts\/63"}],"metadata":[{"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/chapters\/5122\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/wp\/v2\/media?parent=5122"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/chapter-type?post=5122"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/wp\/v2\/contributor?post=5122"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/wp\/v2\/license?post=5122"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}