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Diabetic ketoacidosis is an acute complication of diabetes that poses a direct threat to the life of a diabetic. Untreated ketoacidosis can lead to a diabetic coma and even death. What are the causes and symptoms of ketoacidosis? What does first aid look like in the event of its occurrence? What is the treatment?

Ketoacidosis(diabetic) is a life-threateningcomplication of diabetes . It can occur in all types of diabetes, but most often it is a threat to the life of patients with type 1 diabetes.

Ketoacidosis occurs when there is insufficient or lack of insulin. This hormone, produced by the pancreas, enables the cells in the body to take up circulating sugar (glucose) and use it for energy.

In the case of a deficiency or lack of insulin, it is impossible to collect glucose from the blood. Then it accumulates in excess in the blood (hyperglycemia) and at the same time is missing in the cells. Therefore, they are looking for alternative energy sources that are found in adipose tissue.

Then the breakdown of fats, i.e. lipolysis (in diabetics it is a very intense process), the by-product of which is the so-called ketone bodies (made by the liver) that build up in the body.

This is a very dangerous condition because ketone bodies are acidic and interfere with the normal functioning of life processes. The disorder of these processes is ketoacidosis.

It should be noted that the increase in blood glucose does not always lead to diabetic acidosis. In such situations, the administration of a correction dose of insulin causes the blood sugar level to return to normal. Usually, it occurs when blood sugar levels are elevated, i.e.>250 mg / dl (14 mmo / l). Most, however, it shows up at much higher levels. It lasts for several hours.

Ketoacidosis (diabetic) - causes

Diabetic ketoacidosis is usually a consequence of untreated or poorly treated diabetes (missing insulin dose, taking too little drug, discontinuing treatment, not diagnosing diabetes).

The risk of ketoacidosis increases in patients using a personal insulin pump. Its breakage (broken drain, bent puncture, faulty battery, etc.) can lead tofailure to deliver insulin to the body in adequate amounts.

Other causes of insulin deficiency that lead to the development of ketoacidosis include:

  • acute pancreatitis
  • various types of infections
  • states of increased insulin demand, e.g. heart attack, stroke
  • alcohol abuse
  • pregnancy (in women with type I diabetes, even a slight increase in blood sugar levels can stimulate the rapid formation of ketone bodies)

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Ketoacidosis is often a sign of diabetes

Ketoacidosis is less common in people who are already diagnosed with type 1 diabetes. It often develops at the onset of diabetes, signaling the onset of the disease. It rarely occurs in people with type 2 diabetes.

Diabetic ketoacidosis - symptoms

1. The first symptoms of ketoacidosis are usually symptoms of food poisoning or a gastrointestinal infection:

  • stomach pains
  • nausea
  • vomiting

2. Dehydration that manifests itself:

  • dry mouth
  • weakness and fatigue
  • headaches
  • excessive thirst
  • frequent urination

This is because the body, in order to defend itself against excessive blood glucose, stimulates the thirst center in the brain and increases urination, wanting to excrete as much unnecessary sugar as possible. Typically, however, the amount of urine passed out is greater than the amount of fluid ingested by the sick person, leading to dehydration.

3. The smell of acetone from the mouth

Ketone bodies include acetone, which the body tries to remove through the lungs. Hence the characteristic smell from the mouth, which resembles the scent of rotten apples.

4. An acidic breath, called Kussmaul's breath, which is alternately fast and deep, and then shallow.

5. Redness of the cheeks - acidic flushing (blood vessels widen as a result of ketoacidosis).

Diabetic ketoacidosis - first aid

You should call an ambulance as soon as possible. If the patient is conscious, he should be given fluids, preferably water with lemon, as it has deacidifying properties and balances the level of ions in the body.

It should be given to the patient in small amounts, using a spoon. Drinking the whole glass at once may make you vomit.


Ketoacidosis can lead to a diabetic coma and even death!

Ultimately, consciousness is disturbed as the ketone bodies become toxic to the brain. Lack of medical intervention can lead to a diabetic coma, even death (mortality is 5-10% of cases), usually caused by cerebral edema. That is why it is so important to provide the patient with first aid.

Diabetic ketoacidosis - diagnosis

Upon arrival at the hospital, blood tests are performed, including glucose testing and blood gas testing (to detect acid-base imbalances).

For ketoacidosis, the blood gas measurement is pH<7,3 lub HC03 (stężenie wodorowęglanów w osoczu) 250 mg/dl (14 mmo/l).

In addition, urine tests are performed to assess the presence of ketone bodies.

Diabetic ketoacidosis - treatment

Treatment always takes place in a hospital. The deficiency of intravenous insulin in the pump is replenished and, as a consequence, glycaemia is regulated (it may take up to 2 days). At the same time, it is necessary to supplement intravenous fluids and electrolytes.

In severe acid-base disorders, sodium bicarbonate is administered ad hoc under blood gas control

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