Diabetic Ketoacidosis (DKA)
Diabetic Ketoacidosis (DKA) is a life-threatening
complication that can occur in individuals with uncontrolled diabetes. It
occurs when the body starts to break down fat for energy, resulting in the
buildup of ketones in the blood. The body is unable to use glucose for energy
because the levels of insulin, which regulates blood sugar levels, are too low.
There are three main types of ketones produced by the body:
- Acetoacetic acid: This is the first type of ketone produced when the body starts to break down fat for energy.
- Beta-hydroxybutyric acid: This is the second type of ketone produced, and is a more stable form of ketone.
- 3) Acetone: This is the third type of
ketone, and is the least abundant of the three. It is produced as a byproduct
of acetoacetic acid and is excreted through the breath, giving it a fruity
odor.
In Diabetic
Ketoacidosis (DKA), the primary ketones present are acetoacetic acid and
beta-hydroxybutyric acid. The levels of these ketones in the blood can be measured
using a blood test, such as a beta-hydroxybutyrate test. The presence of high
levels of ketones in the blood is a hallmark of DKA and is used as a diagnostic
criterion for the condition.
The diagnostic criteria for Diabetic Ketoacidosis (DKA) typically include the following:
- Hyperglycemia: Blood glucose levels above 250 mg/dL
- Ketonemia: Elevated levels of
ketones in the blood
- Acidemia: Elevated blood acidity,
with a pH less than 7.3
- Ketonuria: Presence of ketones in
the urine
It is important
to note that the criteria for DKA can vary slightly between healthcare
organizations, but the above parameters are generally accepted as the
diagnostic criteria. The diagnosis of DKA is usually confirmed through blood
tests, such as a complete metabolic panel and a urine test for ketones.
Causes
of DKA include untreated or poorly managed diabetes, stress,
infection, injury, and certain medications. In individuals with type 1
diabetes, DKA can occur if they miss insulin injections or if their insulin
pump malfunctions. In individuals with type 2 diabetes, DKA can occur if they
have a severe illness or if they are not taking their oral medications as
prescribed.
Symptoms of DKA include excessive thirst, frequent urination, fatigue, confusion, abdominal pain, and breathing difficulties. Additionally, individuals with DKA may experience nausea and vomiting, fruity-smelling breath, and a rapid heartbeat. If treatment is not given, DKA can lead to coma and death.
The
treatment plan for DKA involves restoring fluid and
electrolyte balance, controlling blood glucose levels, and removing the ketones
from the body. This typically involves admission to the hospital and
administration of insulin, fluids, and electrolytes. In severe cases, the
individual may require assisted breathing or dialysis.
In conclusion, DKA is a serious complication of
uncontrolled diabetes that requires prompt treatment. It is important for
individuals with diabetes to closely monitor their blood glucose levels and to
seek medical attention if they experience symptoms of DKA. With proper
management, individuals with DKA can make a full recovery and prevent future
occurrences.
Dr.Muhammad Arsalan Khan
MBBS, MSc (Diabetes & Endocrinology)
CCD-BMJ-A K U-RCP (London)
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