Diabetic ketoacidosis facts for kids

Diabetic ketoacidosis (DKA) is a serious medical problem that can happen to people with diabetes mellitus. DKA mostly affects people with Type 1 diabetes. But it can also happen to some people who have Type 2 diabetes.

DKA happens when your body doesn't have enough insulin. Insulin is like a key that helps glucose (sugar) get into your body's cells. Your cells need sugar to make energy and stay alive. Without insulin, sugar stays in your blood and can't get into the cells. This causes high blood sugar and means your cells can't get the energy they need.

DKA can be caused by not taking enough insulin, eating too many carbohydrates, or sometimes by physical or mental stress. DKA can also be the first sign that someone has diabetes that hasn't been found yet, or that their diabetes isn't being managed well.

Doctors find out if someone has DKA by doing blood and urine tests. These tests will show very high blood sugar. This high sugar level helps doctors know it's DKA and not another type of ketoacidosis.

DKA was first discovered around 1886. Before insulin medicine became available in the 1920s, DKA almost always led to death.

What Are the Signs of DKA?

The signs of DKA can include:

• Feeling sick to your stomach and throwing up
• Feeling very thirsty because your body is losing too much water
• The "3 polys" of DKA:
  • Polydipsia: Feeling very thirsty. This happens because your body is dehydrated.
  • Polyphagia: Feeling very hungry. Your brain knows your cells aren't getting enough sugar, so it makes you feel hungry. Normally, eating would give your cells the sugar they need.
  • Polyuria: Peeing a lot. This is your body trying to get rid of the extra sugar in your blood.
• Your breath might smell "fruity." This is called acetone breath. It happens because your body is trying to get rid of extra acids and waste products.
• Pain in your stomach.

As DKA gets worse, you might notice these signs:

• Feeling confused. This gets worse over time because your brain isn't getting enough sugar to work right.
• Feeling very tired (called lethargy). This is because your body can't make enough energy.
• Eventually, a person might go into a coma. This happens when the brain doesn't have enough sugar to stay awake.
• Breathing that is deep, gasping, and difficult. This is called Kussmaul respirations. Your body does this to try and get rid of extra acids.

Without the right treatment, DKA can be very dangerous and can cause death.

How Does DKA Happen in Your Body?

First, when there isn't enough insulin, sugar (glucose) can't get into your cells. So, sugar builds up in your blood. This means you have too much sugar in your blood and not enough in your cells. Your cells start to "starve" because they can't use the sugar for energy.

To try and make energy for your cells, your liver starts to break down fat. When fat breaks down, it creates fatty acids and ketones. These can give a little bit of energy. But they are also acidic. This makes your blood too acidic, which can be harmful to your body.

Because your cells still don't have enough sugar for energy, your liver also breaks down stored sugar called glycogen. (Your body stores sugar in different forms for later use.) However, there's still not enough insulin to let this new sugar get into the cells. So, the sugar stays in your blood, making your blood sugar levels even higher, and your cells keep starving.

Next, your body starts to break down protein. This happens when your body can't make enough energy from breaking down fat and glycogen. Breaking down protein causes your body's tissues to lose something called nitrogen.

Now, there's much more sugar in your blood than in your cells. Your body always tries to keep things balanced, a state called homeostasis. To try and balance the sugar, your cells (which have very little sugar) release water into your blood (which is very sugary). The goal is to make the blood sugar less concentrated. If your cells give up too much water, they can become dehydrated. Because DKA also makes you pee a lot, a person with DKA can get dehydrated very quickly. This dehydration can be a serious medical problem.

Your kidneys try to filter out the extra sugar from your blood. This causes too much sugar in your urine, which is called glucosuria. All this extra sugar going through your kidneys makes you produce more urine. When you pee more, you lose important substances called electrolytes, like sodium and potassium. Without enough electrolytes, your heart, muscles, and nerve cells can't work correctly. Also, if your kidneys work too hard trying to filter all that sugar, they can eventually fail.

How Do Doctors Treat DKA?

People with DKA need to be treated in a hospital. The usual treatment includes:

• Giving insulin. Insulin helps reverse all the changes that cause DKA. It moves sugar from your bloodstream into your cells. Once your cells have enough insulin, they can use sugar to get energy.
• Giving fluids. Because people with DKA can get very dehydrated, they are usually given fluids. Fluids might be given by mouth or through a needle placed in a vein (an IV). The extra fluid helps to dilute the high sugar in the blood. It also replaces the fluids that people with DKA lose from peeing so much.
• Giving electrolytes. Not having enough insulin can lower the amount of electrolytes in your blood. To fix this, electrolytes can be given through a needle placed in a vein.

See also

In Spanish: Cetoacidosis diabética para niños