clinical features of diabetic ketoacidosis

Last reviewed 01/2018

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)


  • 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