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.
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.
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.
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.
