DKA is a serious complication of diabetes and could be life-threatening, but it usually takes many hours to become that serious.
Due to severe or absolute deficiency of insulin
Blood sugar is typically over 250 mg/ dl, ketonemia is present (ketones positive at greater than 1:2 dilution), serum pH is <7.3 and serum bicarbonate <15 mEq/l. In moderate DKA, serum pH is <7.2 and bicarbonate <10 mEq/l. Severe DKA is charac terized by serum pH< 7.1 and bicarbonate <5 mEq/L.
Oxidation of fatty acids in liver generate P-hydroxybutyrate and acetoacetic acid (ketones) which results in acidosis and ketosis. Hyperglycemia results in osmotic diuresis causing dehydration and hypovolemia and can progress to severe dehydration and shock.
Burning fat makes acids called ketones.
Hyperglycemia results in osmotic diuresis causing dehydration and hypovolemia and can progress to severe dehydration and shock. Dehydration also causes lactic acidosis which increases acidosis. Ketosis and acidosis results in electrolyte imbalance and other most diagnostic mani-fes tations of DKA including fruity odor and rapid respi rations (Kussmaul breathing).
Acidosis causes shift of intracellular ions, most importantly potassium, and phosphate, to the extracellular compartment. These are lost in urine in excess amounts resulting in total body potassium and phosphate depletion.
This is complications of DKA, is characterized by headache, bradycardia, altered neurological status and desaturation in an otherwise improving child. The condition most commonly occurs during the first 5-15 hr of therapy. The rate of fluid administration should be reduced. Either IV mannitol (0.25-1 g/kg) over 20 min) or hypertonic (3%) saline (5-10 ml/kg over 30 min) is given to reduce edema.
Patients may present with sequelae of hyperglycemia and dehydration (e.g., sunken eyes, decreased skin turgor, dry mucous membranes), as well as sequelae of ketoacidosis:
Neurologic symptoms (lethargy and confusion)
GI symptoms (nausea, emesis, and abdominal pain)
Tachypnea, with severe cases developing Kussmaul breathing