Emergency Conditions

Ketoacidosis. Diabetic ketoacidosis is a life-threatening complication of type 1 diabetes. It is almost always caused by noncompliance with insulin treatments; infections or other stresses can also increase the risk. Not only is there usually an excessive amount of glucose present in the bloodstream, but fat breakdown accelerates the production of fatty acids; these are converted into chemicals called ketone bodies, which at high levels are toxic.

Symptoms of ketoacidosis include nausea and vomiting and, in children, abdominal pain. Breathing may be abnormally deep and rapid with frequent sighing. The heartbeat may be rapid. If the condition persists, coma and, eventually, death may occur, although over the past 20 years, death from ketoacidosis has decreased to about 2% of all cases. Other serious complications from ketoacidosis include cerebral swelling in children, aspiration pneumonia, and adult respiratory distress syndrome.

The annual incidence of diabetic ketoacidosis ranges from 30 to 80 episodes per 1,000 persons with diabetes. The risk is much higher in adolescents -- both girls and boys -- because they are less apt to comply with insulin therapy. Life-saving treatment includes insulin administration to correct glucose and ketone metabolism and rapid fluid and electrolyte replacement.

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