Diabetic Ketoacidosis (DKA) Quiz
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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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- Confusion
- Easily distracted
- My body is jerking
- Change in mental status
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- Nausea improves with vomiting
- Unable to sit for a long time
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- 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.
Am I in Ketosis? Why Your Body is Reacting & Medically Approved Steps
A.
There are several factors to consider. Common signs include fruity or metallic breath, reduced appetite, and more urination, and you can confirm ketosis by measuring blood ketones around 0.5 to 3.0 mmol/L while staying hydrated, replacing electrolytes, and reducing carbs gradually if symptoms are strong. Equally important, recognize red flags of diabetic ketoacidosis such as severe nausea or vomiting, abdominal pain, rapid breathing, confusion, or high blood sugar with high ketones, which need urgent care; find the full guidance below on who should avoid ketosis, how to monitor safely, and the medically approved steps that could change your next health decisions.
References:
* White, H., & Johnston, C. S. (2018). Physiological responses to ketosis: The effects of carbohydrate-restricted diets on human metabolism. *Nutrition Reviews*, 76(2), 114–126.
* Newman, J. C., & Verdin, E. (2017). Ketone bodies as signaling molecules. *Trends in Endocrinology & Metabolism*, 28(8), 563–573.
* Laffel, L. M. (2016). Ketone Body Monitoring: A Practical Guide. *Journal of Diabetes Science and Technology*, 10(5), 1083–1089.
* Masood, W., Anjum, S., Mushtaq, K., & Arshad, A. (2019). Ketogenic diet in health and disease: a new perspective. *Journal of Clinical & Translational Endocrinology*, 18, 100201.
* Zammit, M. A., Attard, S. M., Scerri, P., Galea, A., & Zammit, M. A. (2021). Common Side Effects and Adverse Events in Patients on a Ketogenic Diet. *Journal of Clinical Medicine*, 10(17), 3848.
Q.
High Ketones? Why Your Blood Is Acidifying & Medically Approved Next Steps
A.
High ketones mean your body is burning fat and your blood can become acidic; when levels rise quickly, especially with high blood sugar or too little insulin, this can lead to diabetic ketoacidosis, a medical emergency. Immediate steps include checking blood sugar, hydrating with sugar-free fluids, following your prescribed insulin sick-day plan, rechecking ketones, and seeking urgent care if levels remain high, you vomit or cannot keep fluids down, you feel confused, or your breathing becomes rapid. There are several factors to consider, including non-diabetic causes and when ketosis is expected; see below for ranges, red flags, prevention tips, and decision points that can change your next steps.
References:
* Gosmanov AR, Kitabchi AE. Diabetic Ketoacidosis. [Updated 2023 Aug 17]. In: Feingold KR, Anawalt B, Blackman MR, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279471/
* Puchalska P, Crawford PA. Ketone Body Metabolism and Its Implications in Energy Homeostasis and Diseases. Metabolism. 2017 Mar;70:2-10. doi: 10.1016/j.metabol.2016.10.007. Epub 2016 Nov 7. PMID: 27838528; PMCID: PMC5367623.
* Maciel M, Teixeira A, Gouveia R, Matos R, Carvalho F, Costa A, Antunes R. Alcoholic Ketoacidosis: Pathophysiology, Diagnosis, and Management. Cureus. 2019 Mar 18;11(3):e4271. doi: 10.7759/cureus.4271. PMID: 30999974; PMCID: PMC6525790.
* Nyenwe EA, Kitabchi AE. The Management of Diabetic Ketoacidosis: An Update. Endocr Rev. 2021 May 24;42(3):291-324. doi: 10.1210/endrev/bnaa023. PMID: 32924128; PMCID: PMC8146740.
* Marra M, Baldi S, D'Alessandro A, Nardiello S, Di Stazio M, Ciuffreda A. Ketoacidosis: biochemical, clinical and therapeutic implications. Eur Rev Med Pharmacol Sci. 2023 Jul;27(13):6048-6058. doi: 10.26355/eurrev_202307_32890. PMID: 37402808.
Q.
Is it DKA? Why Your Blood is Turning Acidic & Medically Approved Next Steps
A.
There are several factors to consider: DKA happens when too little insulin causes ketones to build up and make the blood acidic; warning signs include glucose typically over 250 mg/dL with positive ketones, vomiting or abdominal pain, fruity breath, rapid deep breathing, dehydration, or confusion that require immediate emergency care. Treatment is hospital based with IV fluids, insulin, and electrolytes, and prevention includes not skipping insulin, checking sugars and ketones, staying hydrated, and following sick day rules; see the complete guidance below on risks, diagnosis, when it is probably not DKA, and type 2 considerations, as these details can change your next steps.
References:
* Malik A, Ahmed S, Sarwari S, et al. Diabetic Ketoacidosis in Adults: A Narrative Review. J Clin Med. 2021 Jul 26;10(15):3300. doi: 10.3390/jcm10153300. PMID: 34360699; PMCID: PMC8347493.
* Gosmanov AR, Kitabchi AE. Diabetic ketoacidosis: an update. Endocrinol Metab Clin North Am. 2013 Dec;42(4):727-39. doi: 10.1016/j.ecl.2013.07.001. PMID: 24280918.
* Umpierrez G, Kitabchi AE. Pathophysiology of diabetic ketoacidosis. Endocrinol Metab Clin North Am. 22006 Dec;35(4):735-52. doi: 10.1016/j.ecl.2006.09.002. PMID: 17126207.
* Dhatariya KK. Management of Diabetic Ketoacidosis (DKA) in Adults: An Update. Diabetes Ther. 2019 Jun;10(3):915-925. doi: 10.1007/s13300-019-0621-z. Epub 2019 Apr 4. PMID: 30949774; PMCID: PMC6536965.
* Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN. Diabetic ketoacidosis in adults: a review. Mayo Clin Proc. 22009 May;84(5):460-72. doi: 10.4065/84.5.460. PMID: 19411440; PMCID: PMC2676138.
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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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