5 signs and symptoms of diabetic ketoacidosis (DKA)

For some children, a diagnosis of diabetes comes only after they experience diabetic ketoacidosis (DKA), a potentially life-threatening condition. If your child has diabetes or is at risk for diabetes due to a family history or other factors, understanding DKA and its symptoms can help you respond quickly and get your child the necessary care. Huay-Lin Lo, M.D., Pediatric Endocrinologist at Children's Health℠ and Assistant Professor at UT Southwestern, shares important information on DKA.

What is diabetic ketoacidosis?

Diabetic ketoacidosis, or DKA, is a serious and potentially life-threatening complication of diabetes. Up to 70% of the time, when a child is first diagnosed with diabetes, it's because they are experiencing DKA.

"Children who are developing diabetes have low levels of insulin, a hormone the body uses to absorb blood sugar – the major source of energy for the muscles and other tissues," says Dr. Lo. "When insulin is too low, the body can't use sugar in the blood appropriately. Instead, the body begins to burn fat for energy."

The liver turns the fat into ketones, a type of fuel. However, ketones are acids, and when there are high levels of ketones in the blood, the blood becomes too acidic. This can be toxic, causing a wide range of problems.

What causes diabetic ketoacidosis?

When the body can't use sugar for energy properly, hormones are released that break down fat as fuel, producing ketones. In a person with low insulin levels, the excess ketones build up in the blood faster than they can be consumed as fuel, leading to DKA. There are several reasons a child may have large amounts of ketones:

• Not enough insulin – Can occur if your child missed an insulin dose or did not take enough insulin
• Acute Illness – When your child is sick, his or her body experiences higher levels of stress, which can cause insulin resistance and lead to a higher rate of production of ketones, even without high blood sugars, particularly if your child has vomiting or diarrhea
• Dehydration/Starvation – Ketones can develop if a person is dehydrated or has not been eating enough carbohydrates

What are the symptoms of DKA?

It's essential to know the signs and symptoms of DKA in children, to help recognize it early and ensure timely, targeted therapy.

"DKA has similar symptoms as some common illnesses, which can make it hard to detect," says Dr. Lo. "Know the signs and make sure to talk to your child's doctor about these symptoms if you are concerned."

Signs and symptoms of DKA include frequent urination, increased thirst, increased hunger, unexplained weight loss and flu-like symptoms.

• Frequent urination – High blood sugar levels cause your child to urinate more than usual. However, frequent urination can also be a sign of a urinary tract infection. To determine if it is DKA, a physician can check a urine sample for glucose and ketones.
• Increased thirst – Because your child is urinating more often, they may feel dehydrated and thirstier than usual. You might think your child is peeing more because they are drinking more, but in the case of DKA, the opposite is true.
• Increased hunger – When your child has high blood sugar levels, the body loses sugar through the urine, so they don't get enough calories. Because they are absorbing fewer calories, they may feel extra hungry. However, this is not always the case, and some children eat less because they feel sick.
• Unexplained weight loss – Even though your child may eat and drink a lot, they may lose weight because they cannot absorb the sugars they're eating, and their body may be breaking down fat for energy.
• Flu-like symptoms – As the above symptoms get worse, your child may begin feeling sick. They may experience flu-like symptoms such as nausea, vomiting, dry mouth, abdominal pain and some symptoms unique to DKA, like blurry vision and a fruity odor to your child's breath (due to ketones in their system).

DKA is a serious condition. Always seek medical attention from your pediatrician or another medical professional if your child has the above symptoms. Early recognition can help lessen the severity of DKA in a child and possibly save a child's life.

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