DIABETIC KETOACIDOSIS (DKA)
This past week in Central Wisconsin, a young girl died after suffering from the complications of untreated diabetes. She was in a state of diabetic ketoacidosis (DKA) and suffered a cardiac arrest. DKA is a life-threatening complication for those with untreated diabetes mellitus, who have chronic high blood sugar, and insulin-dependent diabetics. Let’s take a closer look at this treatable, but deadly problem.
What is diabetic ketoacidosis? This is a state in which the body does not produce insulin, resulting in very high levels of blood glucose (sugar). Normal body levels of glucose range from 60-110 mg/dl, while a patient with DKA may well exceed levels of 1000 mg/dl.
When DKA occurs, the body undergoes an energy crisis because it is unable to metabolize the glucose for fuel. In response, the liver begins to break down the fats and proteins of muscle and body organs. If untreated, the body’s chemistry will be altered and the pH level of the blood will be lowered to the point that it is incompatible with life.
What are the causes? Many times, a patient is first diagnosed with diabetes because they arrive in the emergency department with DKA. In known diabetics, a bout of the stomach flu or infections, such as pneumonia, can send a person into DKA. When diabetics do not follow their physician’s instructions and miss their insulin, they are at risk for DKA as well.
What are the symptoms? Symptoms include excessive thirst and urination, extreme weight-loss, muscle wasting, oral thrush or persistent yeast infections, dry mucous membranes, sunken eyes, weakness, sluggishness, shortness of breath, confusion, and an ill appearance. Those suffering from advanced DKA will have a fruity smell to their breath, similar to nail polish remover.
What should be done? DKA is life threatening and the patient must be brought to the emergency department. The patient will be aggressively rehydrated with intravenous fluids, the glucose level will be slowly lowered with small amounts of insulin, and blood chemistries will be monitored. The patient will also be evaluated to determine how he/she progressed to DKA.
Usually, the patient will recover after a day or two in the hospital. However, it is essential the outpatient be closely monitored by a primary health care provider.
DKA is a very serious and life threatening condition that requires medical treatment. Prevention, early recognition of DKA symptoms, and prompt treatment of the patient can prevent death.
