PCCN DKA Overview

PCCN DKA Overview

Pathophysiology

Diabetic ketoacidosis (DKA) is a serious complication of diabetes that occurs when your body produces high levels of blood acids called ketones.  DKA happens predominantly in those with Type 1 diabetes, but it can occur in those with Type 2 diabetes under certain circumstances.  This condition develops when you body can’t produce enough insulin.  Insulin normally plays a key role in helping sugar (glucose) – a major source of energy for your muscles and other tissues – enter your cells.  Without enough insulin, your body begins to break down fat as fuel.  This process produces a buildup of acids in the bloodstream called ketones, eventually leading to diabetic ketoacidosis if untreated.   DKA is medical emergency, and without treatment it can lead to death.

Signs & Symptoms of DKA

DKA s/s often develop quickly, sometimes within 24 hours.  For some, these s/s may be the first indication of having diabetes.

• Excessive thirst
• Frequent urination
• Nausea and vomiting
• Abdominal pain
• Weakness or fatigue
• Fruity scented breath
• Confusion

Causes of DKA

Sugar is a main source of energy for the cells that make up your muscles and other tissues.  Normally, insulin helps sugar enter your cells.  Without enough insulin, your body can’t use sugar properly for energy.  This prompts the release of hormones that break down fat as fuel, which produces acids known as ketones.  Excess ketones build up in the blood and eventually spill over into the urine.

• DKA is usually triggered by
• An illness – an infection or other illness can cause your body to produce higher levels of certain hormones, such as adrenaline or cortisol.
• A problem with insulin therapy – missed insulin treatments or inadequate insulin therapy can leave you with too little insulin in your system, triggering DKA.
• Physical or emotional trauma
• Heart attack
• Alcohol or drug abuse, particularly cocaine
• Corticosteroids and some diuretics

Risk Factors of DKA

• Have Type 1 diabetes
• Frequently miss insulin doses
• May occur in Type 2 diabetes (uncommon)

Complications

DKA is treated with fluids, electrolytes such as sodium, potassium, and chloride and insulin.  Perhaps surprisingly, the most common complications of DKA are related to this lifesaving treatments.

Treatment complications include

• Low blood sugar (hypoglycemia)
• Low potassium (hypokalemia)
• Swelling in the brain (cerebral edema)

Treatment of DKA

• Fluid replacement
• Electrolyte replacement
• Insulin therapy

Prevention of DKA

• Commit to managing your diabetes
• Monitor your blood sugar level
• Adjust your insulin dosage as needed
• Check your ketone levels