Diabetes Ketoacidosis
DKA is a severe metabolic condition in which there is marked hyperglycaemia and greatly elevated levels of ketones in the blood, leading to metabolic acidosis. This means that the acidity of the blood and tissue fluids is raised to an abnormally high level due to a failure of metabolic regulation, causing serious physiological disturbance within the body. The following medical definitions of DKA have been suggested:
"Severe, uncontrolled diabetes requiring emergency treatment with insulin and intravenous fluids, with a blood ketone body concentration of greater than 5 mmol/1"
"A capillary or arterial plasma bicarbonate concentration of less than 15 mmol/1."
"A urinary ketostix reaction of + + or greater."
DKA usually develops rapidly over a period of a few days and produces a number of symptoms and clinical signs. These include:
- excessive thirst and urination (polyuria)
- passing large quantities of urine at night (nocturia)
- rapid weight loss (due to dehydration and metabolic breakdown)
- nausea and vomiting
- muscular weakness and cramps, especially in the legs
- flushing of the face
- abdominal pain, deep
- rapid breathing (known as Kussmaul respiration, caused by acidosis)
- drowsiness and, eventually, coma.
People with DKA are quite often admitted to hospital with persistent vomiting as the most apparent symptom, in the first instance. As acidosis worsens, there is an effect upon the heart and circulation and people with severe DKA may have a rapid heartbeat, arrhythmias and hypotension (very low blood pressure) in addition to the symptoms listed above. Treatment involves skilful management in an intensive care unit and constant, careful monitoring of the person's condition. The aim is to correct the physiological imbalances accompanying dehydration, loss of electrolytes and hyperglycaemia. This involves rehydration with fluids, electrolytes and insulin, all given intravenously. As the person improves, insulin is given by subcutaneous injection and the person will be encouraged to eat normally, as soon as he or she is well enough to do so.
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