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Diabetes: Ketoacidosis



  • Diabetic ketoacidosis (DKA) is a buildup of acids in the blood that can cause coma or death if not treated right away.
  • DKA is a medical emergency and needs to be treated right away at a hospital. Your child will be given insulin, other medicine, and IV fluids.
  • Check your child’s blood glucose (sugar) level to keep it under control, as recommended by your child’s healthcare provider. Ask your child’s provider when you should check for ketones.


What is diabetic ketoacidosis?

Diabetic ketoacidosis (DKA) is a buildup of acids in the blood. If the body does not make enough insulin, glucose (sugar) cannot move out of your child’s blood and into the cells. Your child’s blood glucose can get very high and the body burns fat instead of glucose for energy. This makes byproducts called ketones. When ketones build up to dangerous levels, it is called ketoacidosis. This can cause coma or death if not treated right away. Ketoacidosis may happen with either type of diabetes but is more common with type 1 diabetes.

What is the cause?

DKA can happen if your child skips doses of insulin or as a side effect from certain medicines. Or it may happen if there is a change in your child’s health such as:

  • Infection
  • Injury
  • Surgery
  • Other types of physical or emotional stress

If your child is using an insulin pump, it may happen if your child stops getting insulin because the pump is not working, there is a kink in the tube, or the tube comes out.

What are the symptoms?

Symptoms of ketoacidosis may include:

  • Shortness of breath
  • Fruity smelling breath
  • Very dry mouth
  • Abdominal pain, nausea, or vomiting

Symptoms of high blood glucose may include:

  • Blurry vision
  • Dry mouth
  • Tiredness
  • Increased thirst and drinking a lot
  • Urinating a lot
  • Confusion or a hard time paying attention

If the pancreas stops making insulin, blood glucose can get very high, and ketones can build up to a high level very fast. It may happen so fast that ketoacidosis symptoms may be the first symptoms that your child has before your child has been diagnosed with diabetes.

Several hours to a couple of days after symptoms start, ketoacidosis may result in a coma.

How is it diagnosed?

Your healthcare provider will ask about your child’s symptoms and medical history and examine your child. Your child will have blood and urine tests.

How is it treated?

DKA is a medical emergency and needs to be treated right away, usually at a hospital. Your child will be given insulin and IV fluids. With early treatment, your child will usually recover in hours to days.

How can I take care of my child and help prevent DKA?

  • Good control of diabetes depends on following the meal and physical activity plans prescribed by your healthcare provider to keep your child’s blood glucose in the target range.
  • Check blood glucose levels as often as advised by your child’s healthcare provider. Give additional insulin for high blood glucose as directed by your child’s provider.
  • Give your child or help your child take his or her regular insulin dose as prescribed without missing doses. Make sure your child never takes more insulin than the regular dose unless you have double checked the blood glucose reading and made sure that the glucose level is too high, and your child needs more insulin.
  • If your child wears an insulin pump or continuous glucose monitor (CGM), pay attention to an unexpected rise in blood glucose level and check for a problem in the device, pump settings, or tubing. You may need to give insulin with a syringe for high blood glucose levels while the device is being fixed.
  • Make sure your child drinks plenty of water. Dehydration can cause blood glucose levels to rise, and if not treated, ketoacidosis may happen.
  • Know the early signs and symptoms of ketoacidosis.
  • Ask your healthcare provider when you should check for ketones. Your provider may recommend checking for ketones if:
    • Your child’s blood glucose level is higher than recommended by your healthcare provider (usually around 240 mg/dL.)
    • Your child is ill or under more stress than usual. When your child is sick, ketones can be present even if the blood glucose is not high.

    Let your provider know right away if there are ketones in your child’s urine or blood.

  • Keep extra insulin with you.
  • Do not let your child be physically active if your child’s blood glucose levels are high and there are ketones in the urine.
  • Make sure that your child carries a medical ID such as a card or bracelet that says he or she has diabetes.

Ask your child’s healthcare provider:

  • How and when you will get your child’s test results
  • How long it will take your child to recover
  • If there are activities your child should avoid and when your child can return to normal activities
  • How to take care of child at home
  • What symptoms or problems you should watch for and what to do if your child has them

Make sure you know when your child should come back for a checkup. Keep all appointments for provider visits or tests.

Developed by Change Healthcare.
Pediatric Advisor 2022.1 published by Change Healthcare.
Last modified: 2021-03-15
Last reviewed: 2022-02-05
This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.
© 2022 Change Healthcare LLC and/or one of its subsidiaries
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