Diabetic ketoacidosis

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Diabetic ketoacidosis (DKA) is a serious condition that is associated with diabetes mellitus. DKA happens mostly in those that have Type 1 diabetes, although it may occur in some people that have Type 2 diabetes.

DKA occurs due to a shortage of insulin in the body, which is used to break down glucose into a form that the body can use for energy. DKA is caused by a lack of insulin, high carbohydrate intake, and sometimes physical or mental stress. DKA may be a symptom of undiagnosed or poorly managed diabetes mellitus. Symptoms of DKA include vomiting, dehydration, nausea, strong feelings of thirst, excessive urination, a "fruity" smell on the breath, and abdominal pain. In severe DKA, confusion and lethargy can occur, along with a deep, gasping, labored breathing pattern, and sometimes even a coma.

The condition is diagnosed through blood and urine testing; unlike other forms of ketoacidosis, DKA will manifest with high blood sugar. Without proper treatment, DKA can cause death. It was first discovered around 1886 and was almost universally fatal before the introduction of insulin therapy in the 1920s.

Mechanism[change | change source]

First, glucose builds up in the extracellular fluid (ECF), and the cells go into starvation mode because insulin isn't breaking down that glucose into a form that the cells can use for food. In starvation mode, the liver breaks down fat into fatty acids and acidic ketone bodies in an attempt to feed the cells.

The blood glucose levels continue to increase because the liver is also breaking down glucagon into more glucose, and there is still insufficient insulin in the blood to break it down. Next, the protein begins to break down causing a loss of nitrogen from the tissues. High glucose in the bloodstream causes an osmotic concentration gradient: cells give up fluid (H2O) to the blood and ECF to maintain fluid homeostasis. The glucose in the bloodstream is filtered in the kidney, causing glucosuria. This causes an osmotic diuresis which results in a loss of electrolytes, i.e.: Na+, K+.

Shock, renal failure and coma are possible symptoms of DKA. This all results from the cells' lack of glucose, which starts a chain reaction in the body that creates one problem after another. The best treatment is early detection to prevent serious harm.