Home >Reference Glossary

Diabetic Ketoacidosis (DKA)

DKA is condition that occurs in diabetics due to lack of insulin. Lack of insulin leads to  hyperglycemia and hyperketonemia
with production of  acetoacetic acid and β-hydroxybutyric acid that create metabolic acidosis. Hyperglycemia causes osmotic diuresis which leads to severe dehydration.

Signs and symptoms may include nausea, vomiting, abdominal pain, thirst, excessive urine output, dehydration with tachycardia and hypotension. Breathing may be deep and rapid ( Kussmaul repirations).  The patient's breath may smell "fruity" due to exhaled acetone.

Without treatment DKA progresses to coma and death.

Diagnostic Criteria for Diabetic Ketoacidosis [1]

Plasma glucose >250 mg/dL* , arterial pH <7.3 , and positive serum and/or urine ketones (especially 3β-hydroxybutyrate)

Severity Arterial pH Serum bicarbonate (mEq/L) Mental status
Mild 7.25-7.30 15-18 alert
Moderate 7 - 7.24 10 to <15 drowsy
Severe <7 <10 stupor/ coma

* DKA may occur with relatively low blood sugar levels during pregnancy

Precipitating Factors for Diabetic Ketoacidosis in Pregnancy [2]

Protracted vomiting, starvation , use of β-sympathomimetic agents for tocolysis, infection, new-onset diabetes ,poor control of blood sugars or poor compliance with treatment ,  insulin pump failure ,steroid use for fetal lung maturation or chronic medical disorder

1. Kitabchi AE, et al., Hyperglycemic crises in adult patients with diabetes. Diabetes Care. 2009 Jul;32(7):1335-43. doi: 10.2337/dc09-9032. PMID: 19564476

2.  Diabetic ketoacidosis in pregnancy. Sibai BM, Viteri OA.Obstet Gynecol. 2014 Jan;123(1):167-78. doi: 10.1097/AOG.0000000000000060. PMID: 24463678
3.  Guo RX, et. al., Diabetic ketoacidosis in pregnancy tends to occur at lower blood glucose levels: case-control study and a case report of euglycemic diabetic ketoacidosis in pregnancy. J Obstet Gynaecol Res. 2008 Jun;34(3):324-30. doi: 10.1111/j.1447-0756.2008.00720.x.PMID: 18588610
4. Chico M, et. al., Normoglycemic diabetic ketoacidosis in pregnancy. J Perinatol. 2008 Apr;28(4):310-2. doi: 10.1038/ PMID: 18379571
5. Tarif N, Al Badr W. Euglycemic diabetic ketoacidosis in pregnancy. Saudi J Kidney Dis Transpl. 2007 Nov;18(4):590-3. PMID: 17951948
6. Himuro H, et al., A case of a woman with late-pregnancy-onset DKA who had normal glucose tolerance in the first trimester. Endocrinol Diabetes Metab Case Rep. 2014;2014:130085. doi: 10.1530/EDM-13-0085. Epub 2014 Apr 1. PMID: 24711923
7. Maislos M, et al., Diabetic ketoacidosis. A rare complication of gestational diabetes. Diabetes Care. 1992 Aug;15(8):968-70. PMID: 1505328


Home | About | Disclaimer | Privacy | Contact | Sitemap