Diabetic Ketoacidosis (DKA) Quiz
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Frequent urination
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What is Diabetic Ketoacidosis (DKA)?
A diabetes complication where the body can't use sugar properly, often due to a lack of insulin hormone. Immediate medical attention and hospitalization are necessary.
Typical Symptoms of Diabetic Ketoacidosis (DKA)
- History of diabetes requiring medications
- Difficulty concentrating
- Recent changes in mental state
- Nausea or vomiting
- Seizure
- Fainting
- Sweet and sour-smelling breath or body odor
- Dry mouth
Diagnostic Questions for Diabetic Ketoacidosis (DKA)
Your doctor may ask these questions to check for this disease:
- Have you ever been treated for diabetes?
- Do you have difficulty concentrating?
- Recently, are you more confused than before?
- Have you been experiencing nausea or vomiting?
- Have you experienced any seizures?
Treatment of Diabetic Ketoacidosis (DKA)
Emergency medical care is required. Fluids and insulin will be given through a needle in the vein. Salt-containing solutions may also be provided if there are salt imbalances in the blood. Treatment of the cause, such as infection, is needed as well.
Reviewed By:
Maxwell J. Nanes, DO (Emergency Medicine)
Dr Nanes received a doctorate from the Chicago College of Osteopathic Medicine and went on to complete a residency in emergency medicine at the Medical College of Wisconsin. There he trained at Froedtert Hospital and Children's Hospital of Wisconsin in the practice of adult and pediatric emergency medicine. He was a chief resident and received numerous awards for teaching excellence during his time there. | | After residency he took a job at a community hospital where he and his colleagues worked through the toughest days of the COVID-19 pandemic. |
Hidetaka Hamasaki, MD (Endocrinology)
Dr. Hamasaki graduated from the Hiroshima University School of Medicine and the Graduate School of Medicine, Jichi Medical University. He completed his residency at the Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine Hospital and the Department of Internal Medicine, Kohnodai Hospital, National Center for Global Health and Medicine. He has served in the National Center for Global Health and Medicine Hospital and Kohnodai Hospital and joined Hamasaki Clinic in April 2017. Dr. Hamasaki specializes in diabetes and treats a wide range of internal medicine and endocrine disorders.
Content updated on Apr 4, 2024
Following the Medical Content Editorial Policy
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People with similar symptoms also use Ubie's symptom checker to find possible causes
- Confusion
- Easily distracted
- My body is jerking
- Change in mental status
- I can not concentrate on my work
- Nausea improves with vomiting
- Unable to sit for a long time
- Appears dazed
- Twitching
- My brain is not functioning
- Bile vomiting
- Doesn't know the time
- Less willpower to do things
- Making careless mistakes
- Fever seizures (with fever of >100.4°F / 38°C)
See full list
Symptoms Related to Diabetic Ketoacidosis (DKA)
Diseases Related to Diabetic Ketoacidosis (DKA)
FAQs
Q.
Fruity Breath? Why Ketoacidosis Is Acidifying Your Blood & Next Steps
A.
Fruity or sweet breath can signal ketoacidosis, a medical emergency in which a lack of insulin drives excess ketone production like acetone that acidifies the blood, especially in people with diabetes; there are several factors to consider. See below to understand more. If suspected, act now by checking blood sugar and ketones, drinking water, contacting your doctor, and going to the ER for severe symptoms; prevention steps, look‑alike causes, red flags, and detailed next actions that can change your care decisions are outlined below.
References:
* Gosmanov AR, Kitabchi AE. Diabetic Ketoacidosis. [Updated 2023 Jul 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459392/
* Dhatariya KK, Glaser NS, Howell SK, et al. Diabetic ketoacidosis. Crit Care. 2016 Aug 17;20(1):260. doi: 10.1186/s13054-016-1433-7. PMID: 27530663; PMCID: PMC4986221.
* Umpierrez GE, Kitabchi AE. Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State. Endocrinol Metab Clin North Am. 2018 Sep;47(3):639-661. doi: 10.1016/j.ecl.2018.05.011. PMID: 30122244.
* Kaminetzky M, Dillard B, Tella SH. Etiology, Clinical Features, and Management of Non-Diabetic Ketoacidosis. Clin Diabetes. 2020 Jul;38(3):282-289. doi: 10.2337/cd19-0077. PMID: 32675685; PMCID: PMC7354972.
* Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN. Hyperglycemic crises in adult patients with diabetes. Diabetes Care. 2009 Jul;32(7):1335-43. doi: 10.2337/dc09-9032. PMID: 19564476; PMCID: PMC2699742.
Q.
Is It Diabetic Ketoacidosis? Why Your Blood Is Acidic + Expert Next Steps
A.
Diabetic ketoacidosis is a dangerous, treatable complication of diabetes where too little insulin forces fat breakdown, causing ketones to build up and make your blood acidic. If you have high blood sugar with intense thirst, vomiting, fruity breath, deep rapid breathing, confusion, or severe fatigue, check glucose and ketones and seek urgent medical care since DKA often needs IV fluids, insulin, and electrolytes. There are several factors to consider, so see below for complete guidance on symptoms, testing, who is at risk, other causes of acidosis, and prevention that could change your next steps.
References:
* Pasquel FJ, Umpierrez GE. Diabetic ketoacidosis: A review of pathophysiology, diagnosis, and management. Minerva Endocrinol. 2014 Sep;39(3):283-93. pubmed.ncbi.nlm.nih.gov/25230232/
* Kitabchi AE, Umpierrez GE, Murphy MB, Kreisberg FR. Pathophysiology of diabetic ketoacidosis. Endocr Rev. 2001 Dec;22(6):871-97. pubmed.ncbi.nlm.nih.gov/11739343/
* Dhatariya KK, Glaser NS, Howell SK, Peters AL, Umpierrez GE. Hyperglycemic Crises: Diabetic Ketoacidosis (DKA) and Hyperglycemic Hyperosmolar State (HHS). Diabetes Care. 2020 Dec;43(12):2992-3006. doi: 10.2337/dci20-0016. Epub 2020 Dec 22. pubmed.ncbi.nlm.nih.gov/33355088/
* Misra S, Oliver NS, Dornhorst A, Fitzgerald M, Flanagan D, Newland-Jones P. Diabetic ketoacidosis: novel insights into the pathophysiology, diagnosis, and management. Lancet Diabetes Endocrinol. 2021 May;9(5):329-340. doi: 10.1016/S2213-8587(20)30441-5. pubmed.ncbi.nlm.nih.gov/33862141/
* Li Y, Yuan H, Li A, Huang G, Wang S. Biochemical markers for diabetic ketoacidosis diagnosis and prognosis: a systematic review. Endocr J. 2021 May 28;68(5):545-560. doi: 10.1507/endocrj.EJ20-0570. pubmed.ncbi.nlm.nih.gov/33632943/
Q.
Ketones in Urine? Why Your Body Is Out of Balance & Medically Approved Next Steps
A.
Ketones in urine mean your body is burning fat instead of glucose and can be normal with fasting, low carb diets, illness, or intense exercise, but in people with diabetes they may signal dangerous diabetic ketoacidosis with red flags like high blood sugar, vomiting, abdominal pain, fruity breath, rapid breathing, or confusion. Next steps depend on your situation, ranging from hydration, eating some carbohydrates, and monitoring sugar to contacting your clinician for insulin guidance and seeking emergency care for moderate to high ketones or any DKA symptoms. There are several factors to consider; see below to understand more.
References:
* Jankajova I, et al. Ketonuria. StatPearls. 2023 Feb 16. PMID: 32491624.
* Ismail-Beigi F, et al. Starvation Ketosis. StatPearls. 2023 Jul 31. PMID: 32809623.
* Dhatariya KK, et al. Diabetic ketoacidosis: an update on presentation, complications, and management. Lancet Diabetes Endocrinol. 2020 Dec;8(12):1001-1011. PMID: 33161405.
* Newman JC, Verdin E. Ketone bodies as a therapeutic target in metabolic diseases. Trends Endocrinol Metab. 2020 Apr;31(4):341-355. PMID: 32014138.
* Kolb H, et al. The Role of Ketone Bodies in Health and Disease: A Comprehensive Review. Cells. 2021 Aug 24;10(9):2191. PMID: 34440079.
Q.
Is Keto Safe After 65? A Senior’s Guide to Healthy Fats
A.
Keto can be safe after 65 when personalized and medically supervised, with emphasis on healthy fats, adequate protein, hydration, and regular monitoring; there are several factors to consider, and key risks include muscle loss, dehydration and electrolyte issues, kidney strain, higher LDL, and for people with diabetes the need for medication changes and awareness of diabetic ketoacidosis. Some may do better with a gentler lower carb approach rather than strict ketosis, and certain conditions like advanced kidney or liver disease or specific heart issues may warrant avoidance. See below for practical strategies, who should avoid it, and how to talk with your clinician about safe next steps.
References:
* Vella, V., Trovato, A., Di Nora, A., D'Agata, V., & Filonzi, C. (2023). Safety and Efficacy of the Ketogenic Diet in Older Adults: A Systematic Review. *Nutrients*, *15*(7), 1735.
* Moharram, N. A., El-Haddad, R., Bitar, A., & Cheikh Moussa, O. (2020). Low-Carbohydrate Diets in the Management of Type 2 Diabetes in Older Adults: A Systematic Review. *Current Nutrition Reports*, *9*(4), 362–372.
* Hyde, P. N., Sjaarda, L. A., Hatcher, B. A., & Bales, C. W. (2022). Effects of a Ketogenic Diet on Body Composition, Metabolism, and Physical Performance in Older Adults with Overweight or Obesity: A Pilot Study. *Nutrients*, *14*(16), 3326.
* Trovato, A., Vella, V., Filonzi, C., Zappalà, A., Di Nora, A., Malaguarnera, M., & D'Agata, V. (2021). Dietary Fatty Acids and Cognitive Health in Older Adults: A Narrative Review. *Nutrients*, *13*(6), 2002.
* Tsilianidis, A., & Tsilianidis, G. (2019). Adverse Events Associated with Ketogenic Diet: A Systematic Review of Published Cases. *Journal of Clinical Medicine*, *8*(1), 107.
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Modi A, Agrawal A, Morgan F. Euglycemic Diabetic Ketoacidosis: A Review. Curr Diabetes Rev. 2017;13(3):315-321. doi: 10.2174/1573399812666160421121307. PMID: 27097605.
http://www.eurekaselect.com/article/75114Dhatariya KK, Vellanki P. Treatment of Diabetic Ketoacidosis (DKA)/Hyperglycemic Hyperosmolar State (HHS): Novel Advances in the Management of Hyperglycemic Crises (UK Versus USA). Curr Diab Rep. 2017 May;17(5):33. doi: 10.1007/s11892-017-0857-4. PMID: 28364357; PMCID: PMC5375966.
https://link.springer.com/article/10.1007/s11892-017-0857-4Cashen K, Petersen T. Diabetic Ketoacidosis. Pediatr Rev. 2019 Aug;40(8):412-420. doi: 10.1542/pir.2018-0231. PMID: 31371634.
https://publications.aap.org/pediatricsinreview/article-abstract/40/8/412/35321/Diabetic-Ketoacidosis?redirectedFrom=fulltextEvans K. Diabetic ketoacidosis: update on management. Clin Med (Lond). 2019 Sep;19(5):396-398. doi: 10.7861/clinmed.2019-0284. PMID: 31530688; PMCID: PMC6771342.
https://www.rcpjournals.org/content/clinmedicine/19/5/396Fayfman M, Pasquel FJ, Umpierrez GE. Management of Hyperglycemic Crises: Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State. Med Clin North Am. 2017 May;101(3):587-606. doi: 10.1016/j.mcna.2016.12.011. PMID: 28372715; PMCID: PMC6535398.
https://www.sciencedirect.com/science/article/abs/pii/S0025712516374041?via%3Dihub