Diabetic Ketoacidosis

Infections occurring in a person who has Type-1 Diabetes (DM-1) can cause sudden onset of accumulation of acids (ketones) in the blood, due to inability of the body to regulate its sugar.ย  The condition is called Diabetic Ketoacidosis, or DKA for short. It can be fatal quickly.

Diagnosis is tricky the very first time it happens, before a person even knows they have diabetes.ย  This primarily occurs in children, but is possible at any age .ย  Many clinicians don’t realize this, because DM-1 used to be called “Juvenile Diabetes.” That’s a misnomer, because 1) as noted, it can begin at any age (really!); and 2) when a child with DM-1 grows up to be 50 or 100, it sounds funny to say their illness is “juvenile.”

Patients may complain of excessive thirst, and drinking & urinating a lot.ย  They’re often vomiting, may have abdominal pain.ย  Our main clue may be shallow rapid respirations, over-and-above that expected for fever.ย  Their breath may smell fruity, like nail polish remover.

A simple urine test makes the diagnosis, using a dipstick with results in 45 seconds.ย  High glucose indicates diabetes if not yet diagnosed.ย  A maximum amount of ketones in the urine suggests there may be ketones in the blood (causing too much acid).ย  Testing blood for ketones can only be done in a hospital; if there are maximum ketones in the urine (not just a little), we call an ambulance. Acids in the blood can kill.

DKA usually occurs when a person first gets DM-1, since they’re not on treatment then (or later, if they stop insulin). Indeed, many people get diagnosed with DM-1 when they get DKA. DKA also occurs when a DM-1 patient gets an infection, and the body needs much more glucose than their insulin dose can handle.ย  The infection (in either a known- or a not-yet-diagnosed diabetic) need not be serious, but usually causes fever.ย  DKA can also occur at times of major physical stress, when the body suddenly needs more insulin, such as a heart attack, major accident, or pregnancy (but not emotional stress like an argument or break-up).

To repeat, DKA can be fatal quickly.  Call 911 if you suspect it.

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