What Is the Pathophysiology of Diabetic Ketoacidosis?

The pathophysiology of diabetic ketoacidosis includes all of the unhealthy chemical reactions that occur in the body because of hormone release and uncontrolled elevated blood sugar. The condition may develop in individuals who have gestational, insulin-dependent (type 1), or non-insulin dependent (type 2) diabetes. Diabetics usually learn to recognize the causes and the symptoms of ketoacidosis, along with preventative measures.

When the pancreas releases little or no insulin, glucose cannot enter and nourish cells, and diabetic ketoacidosis begins. Cells begin starving and the body metabolizes fat, liver and muscle cells for glucose and fatty acids in an attempt to find a nutritional resource. Blood sugar continues to rise as nutrients remain locked out of cell membranes. Fatty acids are converted to ketones, which along with sugar, travel to the kidneys.

The kidneys begin an intensive effort to eliminate the ketones and sugar from the blood, which requires increased urinary output that depletes the body of water. The pathophysiology of diabetic ketoacidosis can result in the loss of up to 10% of total body fluids, resulting in dehydration. The fluid loss results in the loss of electrolytes as well, including chloride, potassium, and sodium. As long as blood sugar remains elevated, the cycle continues.


One of the most noted symptoms of ketoacidosis includes a fruity breath odor. Diabetics become extremely thirsty as the body experiences a fluid shortage. They may have abdominal discomfort and decreased appetite, followed by nausea and vomiting. Patients can also develop chest pains or have difficulty breathing. If left untreated, diabetic ketoacidosis may lead to coma and death.

Lowering the blood sugar is the most important step in the treatment of ketoacidosis. Previously diagnosed diabetics may take an additional dose of oral antidiabetic medication or self administer quick acting insulin, on the advice of a physician. The pathophysiology of diabetic ketoacidosis often becomes apparent in individuals with undiagnosed diabetes, and the initial episode of ketoacidosis usually requires hospitalization. Patients immediately receive intravenous fluids and insulin.

Health care personnel also correct the patient's acid/base and electrolyte imbalances. During hospitalization, patients receive information about diabetes and its treatment. They learn how to monitor their blood sugar and urine ketones and are given information regarding proper diet, exercise, and medication administration. Information also usually includes steps the patient must take in the event that his or her blood sugar rises above a certain level.

Causes of ketoacidosis in diagnosed diabetics can include emotional or physical stress. The body also experiences stress during times of illness caused by infections or other underlying medical conditions. Stress causes the release of adrenaline, glucagon, and growth hormones, which trigger insulin resistance that can result in diabetic ketoacidosis.


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