Ketoacidosis: Causes, Symptoms and Treatment
Ketoacidosis is a serious metabolic condition in which ketone bodies accumulate in the blood, lowering its pH. It most commonly occurs in people with diabetes.
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Ketoacidosis is a serious metabolic condition in which ketone bodies accumulate in the blood, lowering its pH. It most commonly occurs in people with diabetes.
What is Ketoacidosis?
Ketoacidosis (also referred to as ketosidosis) is a severe, potentially life-threatening metabolic disorder in which excessive amounts of ketone bodies build up in the bloodstream, causing the pH of the blood to drop dangerously low -- a state known as acidosis. It most commonly occurs as diabetic ketoacidosis (DKA) in people with type 1 diabetes, but it can also affect those with type 2 diabetes or arise from other causes.
Causes
Ketoacidosis develops when there is an insufficient amount of insulin in the body. Without insulin, the body cannot use glucose (sugar) for energy and instead begins to break down fat. This fat metabolism produces large quantities of ketone bodies as a byproduct.
- Insulin deficiency in type 1 diabetes (most common cause)
- Missed or skipped insulin doses
- Infections, physical stress, or illness that increases insulin requirements
- First presentation of previously undiagnosed diabetes mellitus
- Excessive alcohol consumption (alcoholic ketoacidosis)
- Severe fasting or eating disorders (starvation ketoacidosis)
Symptoms
Symptoms of ketoacidosis typically develop over hours to a few days and can worsen rapidly:
- Nausea and vomiting
- Abdominal pain
- Extreme thirst and frequent urination
- Deep, rapid breathing (Kussmaul breathing)
- Fruity or acetone-like breath odor
- Weakness, fatigue, and dizziness
- Confusion or loss of consciousness (diabetic coma)
Diagnosis
Ketoacidosis is diagnosed through several medical tests:
- Blood glucose measurement: Typically significantly elevated (above 250 mg/dL)
- Blood gas analysis: Confirms a reduced blood pH (below 7.35)
- Ketone bodies in blood or urine: Elevated ketone levels confirm the diagnosis
- Laboratory values including electrolytes (potassium, sodium), kidney function, and full blood count
Severity Levels
Ketoacidosis is classified by pH level into mild (pH 7.25--7.30), moderate (pH 7.00--7.24), and severe (pH below 7.00).
Treatment
Ketoacidosis is a medical emergency requiring immediate inpatient treatment, usually in an intensive care unit (ICU).
- Fluid replacement: Intravenous saline solution to correct dehydration
- Insulin therapy: Continuous intravenous insulin to lower blood glucose and stop ketone production
- Electrolyte correction: Particularly potassium levels must be carefully monitored and replaced
- Treatment of underlying triggers such as infections
Prevention
People with diabetes can significantly reduce the risk of ketoacidosis by taking the following precautions:
- Regular blood glucose self-monitoring
- Consistent and correctly adjusted insulin dosing
- Testing for ketone bodies when blood glucose is elevated or during illness
- Seeking prompt medical attention at the first signs of metabolic imbalance
References
- Kitabchi AE et al. - Hyperglycemic Crises in Adult Patients With Diabetes. Diabetes Care, 2009; 32(7): 1335--1343.
- World Health Organization (WHO): Global Report on Diabetes, 2016. Available at: www.who.int
- Eledrisi MS et al. - Overview and Management of Diabetic Ketoacidosis. Current Diabetes Reviews, 2006; 2(4): 417--425.
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Related search terms: Ketoacidosis + Ketoacidaemia