Ketoacidosis: a complication of diabetes

What is ketoacidosis?

Ketoacidosis is the accumulation of ketone bodies (ketones) in the blood. This then causes the blood to become acidic.

Ketones are chemicals made by the body as a by-product when it breaks down fat to make energy. This can happen when there isn’t enough insulin in the body for it to break down sugars for energy, so it uses fat as a fuel instead.

Unfortunately, ketones are harmful and the body will immediately try to excrete them. This will be via the urine and also via the lungs, producing a typically fruity odour to the breath. Untreated, ketoacidosis can be fatal. Fortunately, treatment is available and is usually successful.

Who is at risk of ketoacidosis?

Diabetic ketoacidosis typically occurs when diabetes (especially type 1 diabetes) is present but has not yet been diagnosed, or in people with known diabetes who are not getting enough insulin to meet their needs. This can happen if the person:

  • fails to understand their condition properly and does not recognise the symptoms of poor control or management;
  • has an infection (such as a urinary tract infection or pneumonia);
  • develops another serious illness (such as heart disease);
  • stops or drastically reduces their dose of insulin. Missed doses of insulin mean the body can’t break down sugars and will start breaking down fat for energy, leading to the production of ketones;
  • becomes pregnant (gestational diabetes, a type of diabetes that develops during pregnancy, can also cause ketoacidosis);
  • suffers physical or emotional trauma (such as a car accident or burns); or
  • consumes large amounts of sugar or alcohol.

Any form of stress to the body, particularly that produced by infection, can cause severe ketoacidosis even in mild cases of diabetes — even if you continue to take your insulin. This is because the hormones that your body produces in response to stress oppose the action of insulin, resulting in your body requiring more insulin than usual.

Symptoms of diabetic ketoacidosis

Symptoms may include:

  • excessive thirst;
  • increased urination;
  • tiredness;
  • a flushed appearance, with hot dry skin;
  • nausea and vomiting;
  • restlessness, discomfort and agitation;
  • fruity or acetone smelling breath (like nail polish remover);
  • abdominal pain;
  • deep breathing;
  • low blood pressure (hypotension) due to dehydration; and
  • confusion and coma.

How diabetic ketoacidosis unfolds

Diabetic ketoacidosis occurs when a person fails to take their insulin regularly or in the correct dosage, or because their insulin requirements increase due to illness or infection and extra insulin is not administered. This can cause the person to lapse into a coma (called ketoacidotic coma or diabetic coma). This type of coma may take hours or days to develop. During this time the person will be thirsty and pass a lot of urine, they may be nauseous and vomit and have abdominal pain. If left untreated, the person could die.

Diabetic ketoacidosis is a medical emergency

Diabetic ketoacidosis should be treated in a hospital as a medical emergency. It should be remembered that a person with dangerous ketoacidosis who requires urgent treatment may still be conscious and not in a coma.

Diabetic ketoacidosis causes a loss of water, potassium and sodium in the urine, and treatment will be needed to replace these important elements. Glucose levels will also need to be monitored closely and insulin injections or an insulin infusion given to correct abnormal levels. Antibiotics may be required if an infection is present.

Last Reviewed: 14 September 2009
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