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What is Ketoacidosis?

Nina Z.
Nina Z.

Ketoacidosis is a condition which occurs when a patient experiences a significant drop in insulin and a concomitant rise in glucose levels, usually above 250 mg/deciliter. Essentially exclusive to diabetics and alcoholics, ketoacidosis-- also referred to as diabetic acidosis, DKA, or simply acidosis-- is responsible for approximately 4-9% of diabetic patient hospital visits. Its onset can be triggered by an underlying infection, most often a urinary tract infection (UTI), missed insulin treatments, trauma, stress, and in the case of alcoholics, excessive alcohol consumption coupled with a starvation diet.

The human body produces a series of hormones to assist in the proper digestion and storage of food energy. An imbalance of insulin and glucagons, which regulate blood glucose levels, is primarily responsible for ketoacidosis. In a healthy individual, the production of insulin in the pancreas is stimulated in response to elevated blood glucose levels, such as after a meal. Insulin encourages the body to convert the glucose into glycogen and fatty acid chains which can be stored in body fat for later use. Conversely, in a healthy individual, the production of glucagons is stimulated in response to a blood glucose deficit.

Nausea can be a symptom of ketoacidosis.
Nausea can be a symptom of ketoacidosis.

The body responds to the presence of glucagons by encouraging fatty acid oxidation. Through this process, energy compounds are produced. Acetyl CoA, a by-product of fatty acid oxidation, is converted to ketone groups (acetoacetate, acetone, and beta-hydroxybutyrate), which are an energy source.

Normally, ketone production does not reach dangerous levels. However, in diabetics and alcoholics, it may proceed unregulated due to a lack of insulin and an overabundance of glucagons, or the metabolism of alcohol itself, respectively. Because of the acidic nature of ketone groups, and the overproduction of glucose as a result of excess ketones, ketoacidosis can be highly toxic.

Excessive alcohol consumption can cause ketoacidosis.
Excessive alcohol consumption can cause ketoacidosis.

Common symptoms for this condition can be explained using the pathogenic model described above. During ketoacidosis, excess blood glucose eventually "overflows" into the urine as a metabolic attempt to prevent high glucose concentrations. In doing so, however, essential salts (potassium, sodium, etc) and water are removed. This process, along with the subsequent concentration of the blood and therefore a drop in pH (because of ketones), leads to nausea, vomiting, frequent urination, dehydration, decreased skin turgor, dry skin, decreased perspiration, and ketonuria (presence of ketones in the urine). If left untreated, ketoacidosis can also lead to coma and death.

Skipped insulin injections is just one cause of ketoacidosis.
Skipped insulin injections is just one cause of ketoacidosis.

Ketoacidosis is easily prevented, if proper measures are taken. A diabetic patient should be diligent with insulin treatments, and alcohol should only be consumed in reasonable quantities. If a diabetic or an alcoholic were to experience the symptoms described above, the best treatment approach would be to replenish fluids with an electrolyte solution, such as Gatorade, and seek out a hospital or clinic where fluids can be administered intravenously. If the situation requires the use of medications, insulin will be used for diabetics, and sodium bicarbonate (to normalize serum pH) for alcoholics.

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Discussion Comments


My best friend had diabetic ketoacidosis. It was very clear that she showed some of the signs you have mentioned in your blog. She also however, suffered from bad headaches, confusion, extreme tiredness and irregular gausping breathing.

There are a lot more symptoms out there for diabetic ketoacidosis than you have mentioned. It is important to be aware of all of them as some may apply while others do not.

I did some research into the field for my friend at the time (being a doctor myself) and found some interesting facts and advice on treating diabetic ketoacidosis.


@Anon93549: As a fellow traveler down that road, you have my utmost sympathy. When I was diagnosed, I was so depressed and angry for a long while. My family history is saturated with it, so for me, it was more of a "when" not "if." But I can still understand how you feel.

First, get your doctor to order a diabetes education class for you. This will really help you get a handle on things. It gave me hope.

Second, congratulations on doing the right things! You are 90 percent of the solution. Watch that carbohydrate intake, and always check your glucose before and after intense exercise. You may find that really intense exercise will raise your glucose temporarily, but it should level off in a couple of hours. This is your body's response to the energy you're expending on intense activity. Test two hours after meals and aim for a reading of under 140, once you get your levels under control. Get your A1c under 6.0 as quickly as you can.

Third, keep your stress under control as much as possible. That will run your sugar up faster than a candy bar.

Keep up the exercise and healthy eating! You have great habits already in place and this, above all things, will really help you stay healthy.

There are a ton of forums and resources available online to help you. I recommend you get either to a support group in your community or join one online.

This disease can be controlled, and complications kept to a minimum. At two and a half years from diagnosis, my last A1c was 5.1, and has not been above 5.7 since May 2008.

Keep your chin up. You can get this thing under control and live a long, healthy, productive life! Good luck and God bless!


I am a cyclist who pedals about 80 miles a week on a rode bike. I eat properly, drink plenty of fluids. I don't smoke or eat red meat.

Three weeks ago I went to my primary doctor for my yearly check up. All went well except the results on blood and urine. I had cycled 20 miles in the morning, then played basketball with my son in the evening. About 7:00 that evening, my doctor called, telling me I had to admit myself into the hospital as my sugar was off the charts. I was diagnosed with type 2 diabetes.

I have no family history with my mother in her late 80's still playing tennis, her sister in mid 90's still acting in pictures. I was devastated and totally depressed.

I was instructed to administrate insulin four times daily. Wow. Totally depressed. I am now taking tablets three times daily, checking my blood, my fingers are killing me and looking to a future of uncertainty. Probably a little dramatic. Need advice to take the x off my back, not feel sorry for myself and get on with life, not fearing it. I never have, but I was not prepared for the circumstance.


I was just diagnosed over a year ago with type one Diabetes. I am insulin dependent and take shots as needed on a sliding scale about five times daily and then one long lasting insulin shot at bedtime.

It has been a horrible, rocky road. I was told that the type of Diabetes I have is linked to an Immune defect and I am DKA (Diabetic ketoacidosis) prone. They said that I have "Brittle" Diabetes.

When I catch a cold or have a tooth ache or even stress for that matter, I get thrown, very quickly, within 48 hours, into DKA. But when I am not sick, I control my blood sugars very well. I tried to do preventive measures to stop the DKA but I am never successful.

I never know when to go in to the hospital. Once I went in too early and they sent me home and within four hours I was in an ambulance, in critical condition being transferred to a trauma hospital.

I spent several days in ICU and then a few more recovering on a regular floor. So I am afraid of going to the hospital to early. I recently was discharged from the hospital a week ago, once again with critical levels and in ICU.

Since November, 2008 I have been hospitalized eleven times. I have had no insurance but now I have a very limited plan, however it is enough that going to get to see an Endocrinologist. Maybe they can help?

The doctors say I am lucky but the next time I may not be so fortunate. That scares me because I am only 39, a wife and a mom. Does any one have Any advice or information that may help me? Besides the secondary issues DKA provides (congestive heart failure, neuropathy, etc.)

Mentally I am being broke down and I don't know how to deal. I am hoping that someone may just have answers or an idea or just comforting words. Thank you so much. --Dezi


my husband has just recovered from this and i agree with the above comment. this is a good site when a loved one has experienced it. he was proper poorly and the hospital said it was good job we got him there when we did. otherwise it could have been a lot worse.


Muscle wasting will cause you to have ketones in your urine. So make sure you are eating a well balanced meal and drinking plenty of water.


Why do you get ketones in your urine if you are not alcoholic, not diabetic, and not starving? Me, my sisters, and a roommate get ketones.

My sisters and I also get lightheaded, tingling all over, muscle spasms all over, burning eyes, muscle fatigue, slurred speech.


this is a good site to look at when your loved one just experienced it. my father just got it today and it was very bad. he has not stopped puking. it is not a fun thing to get.

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    • Nausea can be a symptom of ketoacidosis.
      By: ftlaudgirl
      Nausea can be a symptom of ketoacidosis.
    • Excessive alcohol consumption can cause ketoacidosis.
      By: kmiragaya
      Excessive alcohol consumption can cause ketoacidosis.
    • Skipped insulin injections is just one cause of ketoacidosis.
      By: jedi-master
      Skipped insulin injections is just one cause of ketoacidosis.
    • Intravenous fluids and medications may be given to treat severe dehydration caused by ketoacidosis.
      By: ShpilbergStudios
      Intravenous fluids and medications may be given to treat severe dehydration caused by ketoacidosis.
    • If ketoacidosis is left untreated, it can progress and lead to coma and possibly death.
      By: gwimages
      If ketoacidosis is left untreated, it can progress and lead to coma and possibly death.