Clinical features of diabetic ketoacidosis

Clinical presentation of DKA may vary according to the severity and comorbid conditions. The symptoms of diabetic ketoacidosis (DKA) usually develop rapidly over 1 day or less and may include:

• polyuria with polydipsia – commonest presenting symptom
• weight loss
• fatigue
• dyspnea
• vomiting
• preceding febrile illness
• abdominal pain
• polyphagia

Patients may have tachycardia, poor skin turgor, dry mucous membranes, and orthostatic hypotension due to dehydration (1).

Deep (Kussmaul) respirations are seen as a compensatory mechanism for metabolic acidosis (1)

If severely ill, extreme cases may progress to shock, oliguria and anuria.

The breath may have a distinctive fruity smell - ketotic breath; however the ability to detect this smell is absent is a sizeable proportion of the population - and, by extrapolation, the medical population.

Mental status of patient may vary from confusion, drowsiness, progressive obtundation to loss of consciousness and coma (1,2)

Note:

• nausea, vomiting, and abdominal pain that may mimic an acute abdominal condition
• DKA may rarely be precipitated by sepsis, and fever is not part of DKA

Reference:

1. Westerberg DP. Diabetic ketoacidosis: evaluation and treatment. Am Fam Physician. 2013;87(5):337-46.
2. British Society of Paediatric Endocrinology and Diabetes Guideline for the Management of Children and Young People under the age of 18 years with Diabetic Ketoacidosis - updated November 2024