Diabetic ketoacidosis occurs when the body metabolizes fat, liver, and muscle cells for glucose and fatty acids due to a lack of insulin. This leads to dehydration, electrolyte imbalances, and potentially fatal symptoms. Treatment involves lowering blood sugar levels and correcting imbalances, and patients receive education on diabetes management. Stress and illness can trigger ketoacidosis in diagnosed diabetics.
The pathophysiology of diabetic ketoacidosis includes all the unhealthy chemical reactions that occur in the body due to the release of hormones and uncontrolled rise in blood sugar. The condition can develop in individuals with gestational, insulin-dependent (type 1), or non-insulin-dependent (type 2) diabetes. Diabetics usually learn to recognize the causes and symptoms of ketoacidosis, along with preventive measures.
When the pancreas releases little or no insulin, glucose cannot enter and feed the cells, and diabetic ketoacidosis begins. Cells begin to starve and the body metabolizes fat, liver and muscle cells for glucose and fatty acids in an attempt to find a nutrient source. Blood sugar continues to rise as nutrients get locked out of cell membranes. The fatty acids are converted into ketones, which together with the sugar travel to the kidneys.
The kidneys begin an intense effort to clear ketones and sugar from the blood, which requires an increase in urine output that depletes the body of water. The pathophysiology of diabetic ketoacidosis can involve the loss of up to 10% of total body fluids, resulting in dehydration. Fluid loss also results in the loss of electrolytes, including chloride, potassium, and sodium. As long as blood sugar remains elevated, the cycle continues.
One of the best-known symptoms of ketoacidosis includes a fruity breath. Diabetics become extremely thirsty as the body experiences a lack of fluids. They may have abdominal discomfort and decreased appetite, followed by nausea and vomiting. Patients may also develop chest pains or have difficulty breathing. If left untreated, diabetic ketoacidosis can lead to coma and death.
Lowering blood sugar is the most important step in treating ketoacidosis. Previously diagnosed diabetics may take an additional dose of oral antidiabetic drugs or self-administer rapid-acting insulin, as recommended by a doctor. The pathophysiology of diabetic ketoacidosis often becomes evident in individuals with undiagnosed diabetes, and the initial episode of ketoacidosis usually requires hospitalization. Patients receive intravenous fluids and insulin immediately.
Healthcare personnel also correct the patient’s acid/base and electrolyte imbalances. During their hospitalization, patients receive information about diabetes and its treatment. They learn to monitor blood glucose and urine ketones and receive information on proper diet, exercise, and medication administration. The information usually also includes steps the patient should take in the event their blood sugar exceeds a certain level.
Causes of ketoacidosis in diagnosed diabetics can include emotional or physical stress. The body also experiences stress during times of illness caused by infections or other underlying medical conditions. Stress causes the release of adrenaline, glucagon and growth hormones, which trigger insulin resistance which can lead to diabetic ketoacidosis.
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