Ketoacidosis is a variant of metabolic acidosis . It is particularly evident in the context of diabetes mellitus, when there is a total lack of insulin.
What is ketoacidosis?
One of the typical features of diabetic ketoacidosis is the occurrence of high blood sugar levels. As a result, the affected people suffer from fatigue, frequent urination, loss of appetite and thirst.
Ketoacidosis is a form of metabolic acidosis. In most cases, it occurs in type 1 diabetes mellitus. There is an absolute lack of insulin and there is a severe metabolic imbalance. See AbbreviationFinder for abbreviations related to Ketoacidosis.
The typical features of diabetic ketoacidosis (acidification) include a high concentration of ketone bodies in the blood and elevated blood sugar levels. Since ketoacidosis is an emergency, intensive care therapy must be initiated immediately.
Causes
As a rule, ketoacidosis forms an overacidification of the metabolism (acidosis) due to ketone bodies such as acetone. The metabolic imbalance is caused by the accumulation of organic acids such as ß-hydroxybutyric acid and acetoacetic acid in the blood. This reduces its pH value. It is almost always diabetic ketoacidosis, the cause of which is a prolonged lack of insulin.
The lack of insulin means that the body’s cells are no longer able to extract glucose from the blood. In this way, it is only insulin that enables the translocation of the transporter Glut 4 into the cell membranes. In order for glucose to enter a cell, however, this transporter must be present. In the further course, the energy balance of the body cells is not sufficiently covered.
The brain is informed by the cells of the lack of energy. This leads to the release of adrenaline and noradrenaline as well as other insulin antagonists. This results in increased fat breakdown in the adipose tissue. The liver converts the fat that is released into ketone bodies and releases them into the blood.
The lack of insulin in turn means that there is increased fat breakdown in the liver, which leads to the formation of the acetyl-coenzyme acetyl-CoA. Acetoacetate then emerges from this. This is a salt of acetoacetic acid. The acetoacetate acts as an energy supplier within the tissue as part of the starvation metabolism.
In most cases, ketoacidosis is caused by the catabolic state of metabolism due to a lack of insulin. Organic acids accumulate in the blood. Another typical trigger is a pronounced increase in ß-hydroxybutyric acid in the blood due to heavy alcohol consumption.
Doctors then speak of alcoholic ketoacidosis. Alcohol inhibits gluconeogenesis. The same applies to the oxidation of free fatty acids within the liver. Other possible causes of ketoacidosis include SCOT syndrome, which is a congenital deficiency of succinyl-CoA acetoacetate transferase, and several hereditary disorders.
Symptoms, Ailments & Signs
One of the typical features of diabetic ketoacidosis is the occurrence of high blood sugar levels. As a result, the affected people suffer from fatigue, frequent urination, loss of appetite and thirst. In addition, the symptoms of hyperacidity appear.
These primarily include an odor of acetone in the air you breathe, deep breathing, also known as Kussmaul breathing, abdominal pain, nausea and vomiting. Changes in consciousness, loss of consciousness or even a diabetic coma also occur. There is also a risk of dehydration of the body.
If medical treatment is not given, the patient may die. People who suffer from type 1 diabetes mellitus are particularly at risk of ketoacidosis. If, for example, an insulin injection is forgotten, this quickly results in an insulin deficiency, which becomes noticeable through symptoms. There is also an increased risk of infections that are accompanied by fever. If the metabolism collapses, there is a risk of a coma and failure of the circulatory system.
Diagnosis & course of disease
Because ketoacidosis is a medical emergency, the patient needs immediate medical attention and hospitalization. This is where the doctor’s diagnosis takes place. This measures the blood sugar level and the ketone bodies in the urine. A blood sample is also taken from the wrist to check pH and blood gases.
Salts in the blood such as sodium or potassium are also measured and signs of infection are looked for. In the worst case, ketoacidosis can be fatal. However, the patient can recover if the doctor recognizes the symptoms at the right time. Without proper treatment, permanent damage to the brain, heart, and kidneys is possible.
Complications
Ketoacidosis usually results in a severe insulin deficiency. This can have a very negative impact on the life of those affected and usually leads to severe symptoms and complications. Most of those affected suffer from frequent urination, fatigue and exhaustion.
In most cases, the patient’s resilience also decreases enormously. Loss of appetite can lead to underweight and also to deficiency symptoms. It is not uncommon for those affected to also suffer from abdominal pain and nausea and often have to vomit. The everyday life of those affected is severely restricted by ketoacidosis. In the worst case, a loss of consciousness or a coma can occur.
The affected person suffers from fever and a weakened immune system. This can lead to inflammation and infections throughout the body. The person affected can also collapse and injure themselves if they fall. Ketoacidosis is usually treated with medication. Complications arise if treatment is not initiated on time. As a rule, life expectancy is not reduced with this disease.
When should you go to the doctor?
Diabetes patients should consult their doctor if they experience signs of ketoacidosis. Symptoms such as loss of appetite and thirst, frequent urination and tiredness always require clarification by a doctor. Anyone who notices signs such as abdominal pain, bad breath or changes in consciousness should consult a doctor. If a severe fever occurs at the same time, an immediate visit to the doctor is indicated. Ketoacidosis can be treated with medication if caught early enough. Therefore, a doctor should be consulted at the first sign of metabolic acidosis.
People suffering from an infection or type 1 diabetes mellitus are particularly susceptible to the development of ketoacidosis. Anyone who belongs to these risk groups should have the symptoms mentioned immediately checked by a doctor in order to avoid serious complications. If other symptoms appear or the symptoms mentioned suddenly increase in intensity, medical advice is required. The right place to go is the general practitioner or an internist. In the event of a medical emergency, the patient must be taken to a hospital immediately.
Treatment & Therapy
Ketoacidosis is treated in the hospital. The focus is on combating the cause of the metabolic imbalance. The most important therapeutic measure is the intravenous administration of insulin and liquid. In addition, larger amounts of potassium must be administered promptly to counteract hypokalemia. If there is a bacterial infection, the administration of antibiotics can also be useful.
As part of ketoacidosis therapy, intensive care or emergency medical treatment measures are also taken to maintain vital functions. Furthermore, the patient must be monitored in the laboratory so that possible life-threatening changes can be recognized in good time.
Rapid intervention is particularly important in the event of major deviations from the potassium level or blood sugar level. In the case of a greatly increased ketone body value, bicarbonate can also be administered if this is necessary.
Outlook & Forecast
If left untreated or inadequately treated, ketoacidosis can be fatal. Statistically, 5 to 15% of patients die from a ketoacidotic coma. Life-threatening symptoms such as unconsciousness, dehydration and difficulty breathing can occur. If not treated adequately, there is a risk of hypokalemia. Ketoacidosis can also cause lactic acidosis. Cardiovascular failure and infections are other common causes of death from ketoacidosis.
However, if ketoacidosis is detected in time so that it can be treated promptly, the prospects are good. A fast response time, ideally within hours of the onset of the first symptoms, reduces the risk of further deterioration. The temporary shortness of breath that can occur with ketoacidosis will resolve completely with successful treatment.
A rare risk that exists despite successful treatment is the development of cerebral edema. In particular, too rapid normalization of blood sugar is considered a risk factor. Neurological consequential damage as a result is possible. About 1% of patients with ketoacidosis are affected by this complication. Children and young people are particularly at risk.
However, it should be kept in mind that insulin treatment will still be required to prevent further ketoacidosis. The underlying disease can otherwise lead to ketoacidosis again. With the right follow-up treatment, the prospects for a full recovery are very good.
Prevention
To prevent ketoacidosis from occurring in the first place, diabetics must have good blood sugar levels. Type 1 diabetics are advised to always carry an emergency dose of insulin with them. In the event of an infection, it may make sense to increase the insulin dose, which should be done in consultation with the doctor.
Aftercare
In the case of ketoacidosis, those affected usually only have very few follow-up measures available. A diagnosis and subsequent treatment should be initiated early on in order to prevent the further occurrence of symptoms and complications. As a rule, ketoacidosis cannot heal on its own, so the person affected with this disease is dependent on treatment by a doctor in any case.
Most sufferers need to take various medications and antibiotics. The doctor’s instructions should always be followed so that the symptoms can be completely alleviated. If anything is unclear or if you have any questions, you should always consult a doctor first to prevent the symptoms from getting worse.
Various dietary supplements can also be taken to speed healing. When taking antibiotics, it should be noted that they should not be taken together with alcohol. In most cases, no further follow-up measures are necessary after treatment of ketoacidosis. The disease usually does not have a negative effect on the life expectancy of the person affected.
You can do that yourself
The most important self-measure is to prevent the development of diabetic ketoacidosis. To do this, the blood sugar must be correctly adjusted and regularly checked by a doctor. The values should also be measured if you feel unwell. If necessary, you should consult a specialist. Ketone bodies in the urine can be determined using special measuring strips from the pharmacy. If ketoacidosis has already developed, it must definitely be treated as an inpatient.
Various measures support the treatment and alleviate the individual symptoms. First of all, the body must be supplied with sufficient liquid and minerals. In the acute phase of the disease, the diet should consist of foods rich in salt, herbal teas and water. In order to stabilize blood sugar, sweet foods may be consumed in consultation with the doctor. The patient should also rest and take sick leave for a few days. Strenuous physical activity should be avoided as much as possible.
Light gymnastic exercises that get the circulation going and strengthen the immune system are allowed. Follow-up care also includes regular visits to the doctor. The medical professional must ensure that the blood sugar remains stable and that no further complications arise.
