Diabetic Ketoacidosis Treatment Guidelines

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Overview

Diabetic ketoacidosis, or DKA, is a serious complication of diabetes that usually occurs in people suffering from Type 1 diabetes, although it can also happen in patients with type 2 diabetes.

Insulin is an important hormone that allows the glucose in the blood to be used as fuel for the cells in the body. When the pancreas does not secrete enough insulin, the glucose cannot be used for energy to feed the cells.As the body detects that cells are starving, certain mechanisms begin working to convert stored body fats into energy. During the process breaking down stored fat, toxic substances called ketones are released inside the body. Ketones accumulate in the blood, and small amounts are excreted in the urine.

As the body’s blood sugar levels rise, some of them are also excreted in the urine giving a clear warning signal that something is wrong. When the levels of ketones get too high, the body becomes poisoned by them which can lead to nausea, vomiting, confusion, coma and even death.It is important that diabetic patients and their families learn about the different diabetic ketoacidosis treatment guidelines to prevent serious health complications if the condition should arise.

Causes and Symptoms

Infections such as pneumonia and urinary tract infections are some of the common causes of DKA. Infections can increase the levels of stress hormones, like cortisol, which in turn can increase blood sugar levels.

Injecting an insufficient amount of insulin, or using insulin that has gone bad, can result in the rapid rise of blood glucose levels, and eveually to ketoacidosis.Undiagnosed diabetes and other conditions, including heart attack, trauma, stress and excessive intake of sports drinks and sodas, can also lead to DKA.

The problem with DKA is that symptoms can start slowly and may be mistaken for other ailments. The signs of DKA include excessive thirst, fatigue, dehydration, confusion, abdominal pain, nausea, fever, and unconsciousness. A fruity or acetone smelling breath may also be noticed.

Treatment

Give an affected patient fluids, either orally or intravenously, until he is rehydrated. Fluids will replace those that have been lost through frequent urination, and will dilute the high amount of sugar in the blood.

Electrolyte replacement is also done to treat DKA. Electrolytes, like chloride, potassium and sodium, are important minerals which aid in several body functions. The lack of insulin in the body can result in decreased electrolyte levels, and given intravenously, they can help to keep the heart and the nerve muscles fully functioning.

Together with fluid and electrolyte infusion, insulin therapy is also given to the patient. Insulin usually reverses the very process causing DKA. Administration of insulin is usually stopped whenever the blood glucose level goes down below 240 mg/dL. The patient may then resume his normal insulin therapy.

Preventive Measures

Diabetics should have regular medical check ups. Frequent testing of their blood glucose levels, preferably many times a day, is also encouraged in a patient with diabetes.Patients also need to know how to adjust their insulin dosage to compensate for different foods or levels of exercise as instructed by their physician.

Testing ketones in the urine by using commercially available testing kits can greatly help. When levels are high, it is best to seek the advice of a medical professional.

References

MayoClinic: Diabetic Ketoacidosis

eMedicine: Diabetic Ketoacidosis