Ketoacidosis is a condition in which severe insulin deficiency leads to dangerous effects in the bloodstream. People with type 1 diabetes are at risk of ketoacidosis if their insulin levels become extremely low. This risk can be exacerbated by conditions such as dehydration and infection. Ketoacidosis treatment generally includes the replacement of fluids and electrolytes and the administration of drugs to restore insulin levels and to reduce blood glucose and ketone levels.
Diabetic ketoacidosis is the result of three metabolic problems occurring in conjunction with one another: high blood sugar, high blood ketone levels and a condition called metabolic acidosis. The root cause of the condition generally is extremely low insulin levels. Low levels of insulin lead directly to high blood sugar. With no glucose to use for energy, the body begins to break down fats, producing ketones as a byproduct of fat metabolism. Excess ketones then accumulate in the bloodstream, eventually leading to metabolic acidosis, which causes the blood to become dangerously acidic.
People with diabetic ketoacidosis often are dehydrated in addition to being hyperglycemic, because the condition both causes dehydration and is exacerbated by it. Therefore, ketoacidosis treatment typically includes intravenous fluid replacement and intravenous electrolyte replacement in addition to administration of insulin and medication. For the purposes of ketoacidosis treatment, insulin generally is administered intravenously so that insulin levels can be returned to normal as quickly as possible.
Rapid administration of fluids, electrolytes and insulin is crucial in managing diabetic ketoacidosis, because this condition is fatal if not treated. If treatment is not administered, the diabetic person can slip into a coma and eventually will die. The mortality rate of this emergency condition is 2 percent when the correct treatment is administered promptly.
Although diabetic ketoacidosis is dangerous, the complications of ketoacidosis treatment also can be dangerous. For example, if treatment is administered without sufficient potassium supplementation, blood potassium levels can become dangerously low, potentially affecting heart function. Another possible complication is brain swelling, which can occur if blood sugar levels are adjusted too quickly. Children and newly diagnosed diabetics generally are at greater risk of brain swelling than adults or long-term diabetics.
Following this emergency treatment, further diabetic ketoacidosis treatment might include diagnostic tests to determine whether the ketoacidosis had a specific trigger. In some cases, the trigger is an infection or another underlying medical problem that might itself require treatment. In some cases, an episode of ketoacidosis can occur in someone with undiagnosed diabetes. When this occurs, follow-up treatment includes the development of a plan to manage the condition.