What is diabetic ketoacidosis (DKA) and what should I do if I suspect it in my child or teenager?

Diabetic ketoacidosis (DKA) is a serious and potentially life-threatening medical emergency, occurring primarily in children and adolescents with type 1 diabetes [4]. This condition arises when the body cannot produce enough insulin, the hormone responsible for helping the body's cells use glucose (sugar) for energy. Without sufficient insulin, high levels of sugar build up in the bloodstream, and the body begins to burn fat for energy, causing harmful acids called ketones to accumulate in the bloodstream, making the blood abnormally acidic [1].

Signs and symptoms of diabetic ketoacidosis

Symptoms of diabetic ketoacidosis usually develop within 24 hours, but they can occur more rapidly [4]. Parents and teachers should pay close attention to them, especially in children already diagnosed with diabetes or those not yet diagnosed [4]. Warning signs that require immediate intervention include:

• Extreme thirst and a frequent need to urinate [4].
• Extreme fatigue or feelings of drowsiness or confusion [4].
• Stomach pain, nausea, or vomiting [4].
• Breathing more deeply than usual [4].
• Breath that smells fruity (like nail polish remover) [4].
• Blurred vision [4].

In many cases, these symptoms are preceded by signs of severe hyperglycemia, such as excessive thirst and frequent urination, which are general symptoms of diabetes that always require medical follow-up [2].

What to do if you suspect diabetic ketoacidosis

If you suspect that your child or teenager has diabetic ketoacidosis, do not try to diagnose the condition yourself or delay seeking help. Diabetic ketoacidosis is a medical emergency that requires immediate attention at the nearest hospital emergency department [4]. Early treatment is the most important factor in saving the child's life and preventing serious complications.

The role of ketone testing and prevention

The medical team may recommend testing for ketones at home using a blood ketone meter or urine test strips, especially if the child is sick or experiencing unexplained high blood sugar levels [4]. High levels of ketones are a strong indicator that the body lacks insulin and needs an immediate adjustment to the treatment plan to prevent slipping into full-blown diabetic ketoacidosis [3]. If the blood ketone test shows a level above 3 mmol/L, or more than 2+ in urine, you must contact emergency services immediately [4]. Ketone levels between 1.6 and 3 mmol/L in the blood indicate a risk of DKA, and you should speak with your diabetes care team for advice [4].

The importance of adhering to the diabetes treatment plan

To reduce the risk of DKA, strict adherence to the daily diabetes management plan is necessary. This includes monitoring blood sugar levels regularly, using insulin as prescribed by the doctor without reducing or skipping doses, and maintaining a healthy lifestyle [1]. For more details on symptoms that warrant examination, you can view our article on Type 1 Diabetes in Children: Thirst, Urination, and Ketoacidosis (Arabic).

Medical references

• Diabetes in Children and Teens
• Diabetic ketoacidosis - NHS
• Diabetes Tests & Diagnosis - NIDDK
• Managing Diabetes