Symptoms of Ketoacidosis

Diabetic ketoacidosis (DKA) is a serious and sometimes life-threatening complication that can lead to diabetic coma or death if not treated immediately. DKA most frequently occurs in those with type 1 diabetes, but in rare cases it may happen in people with type 2 diabetes.

Symptoms develop quickly—usually over 24 hours—and range from nausea or vomiting to extreme fatigue and trouble thinking clearly. DKA is commonly triggered when you are under stress—like being sick—or when taking medications that change how your body handles glucose.

Frequent Symptoms of Diabetic Ketoacidosis

DKA presents with a myriad of vague signs and symptoms like nausea, vomiting, and abdominal pain. People with DKA may also have increased thirst and urination, also called polyuria. Some may report smelling a fruity odor on their breath, although this is more frequently observed during a physical examination by a healthcare professional. Severe cases may also be characterized with low blood pressure (hypotension) or difficulty thinking clearly (altered sensorium).

DKA symptoms typically occur as a constellation of warning signs. The first signs include:

• Increased thirst
• Frequent urination
• High blood glucose (blood sugar) levels
• High levels of ketones in the urine (which is sometimes identified when there is a fruity smell to the urine; you can detect ketones via a urine test using a test strip)

The second set of signs includes:

• Extreme fatigue
• Flushed skin
• Feeling dehydrated (often characterized by dry skin or dry mouth)
• Nausea
• Vomiting
• Abdominal pain 
• Rapid shallow breathing (called Kussmaul breathing)
• Fruity odor on breath
• A hard time paying attention, or confusion

Although the symptoms of DKA are progressive in nature, it is important to note that there is tremendous overlap between the two groups. It is not entirely uncommon for early symptoms of DKA to be extreme fatigue or dehydration instead of increased thirst or frequent urination.

Rare Symptoms of Diabetic Ketoacidosis

DKA-related deaths are usually low among those who receive standardized treatment, which includes:

• Administration of insulin
• Correction of hydroelectrolytic disorders
• Management of the triggering factor, which is often cessation of insulin therapy, an infection, or a heart attack

The symptoms of DKA develop quickly and can lead to a coma. It is unknown why the progression to rare symptoms like coma happens more quickly in some people than others, but those who develop DKA following an infection may be at higher risk.

Additionally, cerebral edema is a rare but severe complication that occurs predominantly in children. Symptoms of cerebral edema include:

• Headache
• Neck pain or stiffness
• Nausea or vomiting
• Dizziness
• Irregular breathing
• Vision loss or changes
• Memory loss
• Inability to walk

Complications of Diabetic Ketoacidosis

Complications from DKA result from the body’s inability to produce insulin.

When insulin is not present to break down sugars to use for energy, your body begins to break down fat instead. Fat breakdown produces ketones that spill into the urine and cause glucose to build up in the blood, acidifying the body.

Because sugar is not entering the body’s cells for energy breakdown, the sugar is processed by the kidneys and excreted through the urine. As a result, dehydration occurs and the blood becomes even more acidic.

When blood sugars are sky-high, hydrating with water or caffeine-free, sugar-free liquids may not be enough to ameliorate the problem, leading to sickness and hospitalization. 

If left untreated, complications can include:  

• Cerebral edema
• Cardiac arrest
• Kidney failure
• Low potassium levels

Low potassium levels are especially dangerous because potassium is needed for the heart to function properly.

When higher blood sugar and ketone levels damage the kidneys, potassium is lost, sometimes at a level that may negatively impact the heart. This is especially problematic in older adult populations with pre-existing heart conditions and those who are severely overweight because their heart cannot meet the increased physiological demands placed on the body. 

When to Seek Medical Attention

Diabetic ketoacidosis progresses quickly, so monitoring your symptoms is very important to get the treatment you need. If you have any form of diabetes and a high blood glucose level—greater than 250 mg per dL—or moderate elevations that do not respond to your home insulin treatment, you should contact a healthcare provider.

If you develop symptoms such as fever, vomiting, confusion, or difficulty breathing, seek immediate medical attention. Getting timely medical treatment can help you avoid serious complications like:

• Heart attack
• Kidney failure
• Cerebral edema
• Coma
• Death

How to Prevent Diabetic Ketoacidosis

Insufficient insulin, often by missing or under-dosing insulin, is the number one trigger for DKA, so taking insulin as prescribed is the main way to prevent DKA.

Since the majority of DKA cases occur in patients with a known history of diabetes, the condition is largely preventable via early detection. The education of patients, healthcare professionals, and the general public on the importance of routine exercise and eating a low-sugar diet can decrease overweight rates, curbing diabetes rates in the general population.

Research also shows that the frequency of hospitalizations for DKA has been reduced following diabetes education programs, improved follow-up care, and access to medical advice.

A Word From VeryWell

Oftentimes high ketone levels occur when you do not have enough insulin or haven’t eaten enough. High levels of ketones and high blood glucose levels can mean your diabetes is out of control. If you are diabetic, taking your insulin as prescribed, eating low-sugar meals, monitoring how you feel, and checking both your blood sugar and ketone levels regularly can help you avoid DKA.

Attending regular doctor’s visits may also help keep you on track, although healthcare professionals are not readily accessible to all, underscoring the importance of knowing DKA symptoms.