Ketoacidosis: Symptoms, Diagnosis & Treatments

The most common cause of diabetic ketoacidosis is dehydration in diabetes patients. 

The body becomes distressed and hormones like glucagon and adrenaline start to break down muscle, fat and liver cells and turn them into glucose, or sugar, along with fatty acids to use them to power the body. Those fatty acids are then turned into ketones through oxidation, when oxygen is combined with those fatty acids. Then, your body starts to essentially “eat” its own fat, liver, and muscle cells in order to stay fueled.

Your body goes from using carbohydrates from the food you eat to provide energy to using fat cells for fuel. Your blood sugar level starts to increase, as your insulin can’t keep the extra sugar being produced. That extra sugar ends up in your urine, causing more urination and in turn dehydration. Usually, you lose about 10 percent of all of your body fluids throughout diabetic ketoacidosis. Potassium and other salt levels also decrease significantly because of increased urination.

The illnesses that can lead to a diabetic person to get ketoacidosis include excessive diarrhea and vomiting. It can also be induced by missing a dose of insulin, or diabetes that has gone undiagnosed. Less common causes of ketoacidosis include heart attack, stroke, drug and alcohol abuse, and stress.

The symptoms of diabetic ketoacidosis come on suddenly, and can even develop under 24 hours. Some people who have not been diagnosed with diabetes first find out they have the disease because they experience an episode of diabetic ketoacidosis. So you need to know "what is ketoacidosis" and its symptoms. The major signs include:

• Being very thirsty

• Urinating more than normal

• Feeling nauseous and vomiting

• Stomach pain

• Tiredness or weakness

• Feeling short of breath

• Breath smells fruity

• Confusion or disorientation

If you have been diagnosed with diabetes, you can test your blood sugar to see if it’s extremely high (hyperglycemia) and there are also urine tests that can be taken at home that will find out if you have an increased ketone level.

If you’re going through an infection, surgery, or other illness, it’s best to check your blood sugar more than usual to make sure your blood sugar level is stable. Call your doctor right away if you’re vomiting and can’t keep food or liquid down. Also contact them if your blood sugar levels are higher than normal and can’t be controlled through insulin treatment.

Go to the emergency room or call 911 if your blood sugar level is higher than 300 milligrams per deciliter or 16.7 millimoles per liter consistently, if you have ketones in your urine and can’t get in touch with your doctor, or if you have multiple of the above signs and symptoms of diabetic ketoacidosis.

Blood sugar level

Once your body doesn’t have enough insulin, your body will let cells absorb sugar, so your blood sugar levels will start to increase. Once your body keeps breaking down protein and fat to fuel itself, blood sugar levels keep increasing.

Ketone level

As your body continues to break down fat and protein, those acids called ketones start invading your bloodstream.

Blood acid level

Once you have a large amount of ketones in your bloodstream, your blood starts to turn acidic, which has a negative impact on the function of major organs.

Other tests

Other tests that may be helpful in diagnosing diabetic ketoacidosis and its underlying cause include blood electrolyte tests, an electrocardiogram, urine tests, and a chest x-ray.

Knowing "what is ketoacidosis" is not enough. If you are diagnosed with the problem, learn how it will be treated and what you should pay attention to live with it.  

• Fluid replacement/insulin treatment: This is the most important treatment for diabetic ketoacidosis. The administration of these treatments via IV helps reverse dehydration, decrease the level of acid in the blood, regulate blood sugar levels, and re-balance electrolyte levels. The fluids must be given carefully, as too much can cause the brain to swell.

• Constant insulin administration: Insulin must be given constantly to stop the creation of ketones and to make sure potassium stays in the body balanced. Once the blood sugar levels are under control, glucose may be given along with insulin to avoid low blood sugar.

• Hospital monitoring: Since diabetic ketoacidosis can develop so quickly, you will likely have to stay in the hospital for a few days as doctors need to make sure all your blood functions return back to normal.

• Continuous fluid intake: If you don’t get a severe case of diabetic ketoacidosis, you may be sent home and told to stay hydrated and monitor blood sugar levels. Call your doctor if there is anything wrong. 

Once you’re home, this is how to take care of yourself and prevent another episode of ketoacidosis.

• If you only have a mild case of diabetic ketoacidosis, you will be treated for any pressing symptoms. You will have a follow-up appointment with your doctor later in the week.

• Whether you’re admitted to the hospital or sent home, it is vital to keep checking your blood sugar and ketone levels in your urine. You can keep higher blood sugar levels under control with extra insulin doses and by continuing to drink fluid.

• Make sure you go to your doctor consistently to get your blood sugar levels under control for the long-term. Get your hemoglobin A1C, kidney function and cholesterol levels checked regularly.