Ketoatsidoosi

Ketoatsidoosi, also termed ketoacidosis, is a life‑threatening metabolic condition characterized by high ketone levels and a significant metabolic acidosis. It most commonly refers to diabetic ketoacidosis (DKA), but can also occur in alcoholic ketoacidosis, starvation ketoacidosis, or other settings with insulin deficiency or impaired carbohydrate utilization. The central problem is excessive ketone production due to insufficient insulin activity and increased counterregulatory hormones, leading to an anion gap acidosis.

Common signs and symptoms include excessive thirst and urination, weight loss, nausea and vomiting, abdominal pain, fatigue, rapid or labored breathing (Kussmaul respiration), fruity breath, and sometimes confusion or unconsciousness. Dehydration and tachycardia are frequent; children may present with abrupt onset of symptoms.

Diagnosis relies on clinical presentation plus laboratory findings. Typical features are elevated blood glucose (often above 250 mg/dL), low blood pH (<7.3) or low bicarbonate (<18 mEq/L), and presence of ketones in blood or urine. Electrolyte disturbances, especially potassium, are common and require careful management. Other potential triggers such as infection, acute illness, missed insulin doses, or alcohol use should be identified.

Management is urgent and usually conducted in a hospital, often in intensive care for severe cases. Treatment involves aggressive fluid resuscitation, electrolyte correction (notably potassium), and insulin therapy once initial fluids are given. Identification and treatment of the precipitating cause are essential. Patients require close monitoring of vital signs, glucose, electrolytes, and acid–base status.

Prognosis improves with prompt treatment; mortality is low in well-resourced settings but higher when care is delayed or underlying conditions are severe. Prevention focuses on good diabetes control, adherence to treatment plans, hydration, and early recognition of warning symptoms.