Symptoms of Diabetic Ketoacidosis (DKA)
Symptoms of Diabetic Ketoacidosis (DKA): Commonly we will see the person present with nausea and vomiting, often unable to keep anything down - food or fluids. In turn, they're often bent over with cramping and acute abdomen pain. As their blood glucose levels rise, and as they can't actually keep food and fluid down, they're often very dehydrated and initially they have polyuria with high amounts of glucose in that urine. As they become very dehydrated their renal function will actually markedly reduce and so they'll actually not be voiding very much. Initially we see a rise in heart rate and you'll have ketone production. You'll see a rise in respiratory rate and then as things deteriorate you'll see a change in mental state, maybe some confusion, even delirium. As dehydration really starts to set in you'll notice skin changes, sunken eyes, extremely dry mucous membranes, and then those initial symptoms are seen then in reverse. The raised respiratory rates suddenly drop, the raised heart rate drops, and in fact, people will even drop the core body temperature, becoming hypothermic. A coma could occur; we don't see it that often but it still can happen. Now in addition, when we're talking about very young children presenting in DKA (and remember this could be the first presentation of unknown, undiagnosed type 1 diabetes) there is the additional concern of cerebral oedema occurring. And again, it's very important looking at whether the child has a headache and loss of light reflex with their eyes. This can be, in itself, a fatal condition.