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 Medical Abbreviations: A Closer Look at DKA
Diabetic Ketoacidosis (DKA) is a state of inadequate insulin levels in the blood. When the body does have enough insulin, the blood sugar rises and an accumulation of ketones in the blood occurs. Therefore the muscle, fat and liver cells are unable to use glucose in the body as fuel. In other words, the body changes from using carbohydrates for fuel to a fasting state of using fat for fuel.
Abbreviation |
Meaning |
DKA |
Diabetic Ketoacidosis |
A diagnosis of Diabetic Ketoacidosis is when the plasma glucose concentration is above 250 mg (hyperglycemia), their ph is less than 7.30(acidosis) and the bicarbonate level is 18mEq or less. The key features of Diabetic Ketoacidosis are hyperglycemia ketosis and acidosis. Common problems that can produce ketosis include alcoholism and starvation.
Typically Diabetic Ketoacidosis is caused by infection, missed insulin dose, new-onset diabetes, cardiovascular disease (especially Myocardial Infarction). Alcoholism and starvation can set off the symptoms that can lead to Diabetic Ketoacidosis. Symptoms of Diabetic Ketoacidosis include:
- Excessive Thirst
- Frequent Urination
- General Weakness
- Vomiting
- Loss of Appetite
- Confusion
- Abdominal Pain
- Shortness of Breath
- Dry skin
- Increased Heart Rate
- Low Blood Pressure
- Fast breathing
- Distinctive Fruity odor noted on breath
The American Diabetes Association admission guidelines are 1) plasma glucose concentration better than 250 mg/dL, 2) arterial pH level below 7.30, 3) serum bicarbonate level less than 18 mEq and 4) at least a moderate level of ketones (noted in serum or in urine). A majority of the patients are able to care for themselves at home to curve the response of the body to a lack of insulin. Most times this is done by administering appropriate forms and doses of insulin. For those that do require hospitalization, the most important course of treatment is to have intravenous fluids replacement. This reverses dehydration and dilutes glucose and acid levels. Potassium is often added to the IV fluids. The imbalance caused by Diabetic Ketoacidosis can affect potassium levels which can lead to cardiac implications. Fluid placement alone will lower blood glucose levels as a result of the correction of dehydration.
Insulin is also administered in order to combat high blood glucose levels and recent research has indicated that IV is the best route for administration (over oral and subcutaneous administration) because it allows for a more rapid onset of action. Its main function is to as quickly as possible lower the blood sugar and to prevent further ketone production. Once blood glucose levels have fallen under the critical 250mg additional glucose may be given and closely monitored. This is done to prevent the patient from going from the extreme of high blood sugar to critically low blood sugar levels.
Death can occur from Diabetic Ketoacidosis in about two percent of the affected population. Other complications that can occur from Diabetic Ketoacidosis are infection, stroke and heart attacks. Complications that can occur as a result of treatment to correct Diabetic Ketoacidosis are hypoglycemia (low blood sugar), low potassium, and fluid build up in the lungs, or swelling of the brain. However, most patients with appropriate treatment make full and complete recovery.
References:
1. Trachtenbarg, D.E. Diabetic Ketoacidosis. American Family Physician 2005; 71, 1705-1714
2. Ekedrusi, M.E. Diabetic Ketoacidosis. (2005) Retrieved March 2007 from http://www.emedicinehealth.com
3. American Diabetes Association. Ketoacidosis. Retrieved March 2007 from http://www.diabetes.org
4. Mayo Clinic Diabetic Ketoacidosis (2006). Retrieved March 2007 from http://www.mayoclinic/health/diabeticketoacidosis/DS00674
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