Symptoms and Detection of Ketoacidosis


These symptoms are due to the ketone poisoning and should never be ignored. As soon as a person begins to vomit or has difficulty breathing, immediate treatment in an emergency room is required to prevent coma and possible death.

Early Signs, Symptoms: Late Signs, Symptoms:
  • very tired and sleepy
  • weakness
  • great thirst
  • frequent urination
  • dry skin and tongue
  • leg cramps
  • fruity odor to the breath*
  • upset stomach*
  • nausea*
  • vomiting*
  • shortness of breath
  • sunken eyeballs
  • very high blood sugars
  • rapid pulse
  • rapid breathing
  • low blood pressure
  • unresponsiveness, coma
* these are more specific for ketoacidosis than hyperosmolar syndrome

Everyone with diabetes needs to know how to recognize and treat ketoacidosis. Ketones travel from the blood into the urine and can be detected in the urine with ketone test strips available at any pharmacy. Ketone strips should always be kept on hand, but stored in a dry area and replaced as soon as they become outdated. Measurement of Ketones in the urine is very important for diabetics with infections or on insulin pump therapy due to the fact it gives more information than glucose tests alone.

Check the urine for ketones whenever a blood sugar reading is 300 mg/dl or higher, if a fruity odor is detected in the breath, if abdominal pain is present, if nausea or vomiting is occurring, or if you are breathing rapidly and short of breath. If a moderate or large amount of ketones are detected on the test strip, ketoacidosis is present and immediate treatment is required.

Symptoms for hyperglycemic hyperosmolar syndrome are linked to dehydration rather than acidosis, so a fruity odor to the breath and stomach upset are less likely.

How To Detect Ketones

During any illness, especially when it is severe and any time the stomach becomes upset, ketone levels should be determined. Never assume an upset stomach is due to food poisoning or the flu without determining if ketones are the cause. During any prolonged illness, ketones should be tested every 4 hours.

After ketones are formed from fat metabolism, they collect in the blood and are excreted into the urine. There are two ways to measure ketones at home:

  • in the blood with a specialized meter, like the Precision Xtra™, which measures both sugar and ketones in blood. This is the fastest way to tell if ketones are rising, and the best method for parents to use to quickly decipher whether a child’s illness is ketoacidosis or something else.
  • in urine with test strips like Ketostix (measures ketones only) or Ketodiastix (measures ketones and glucose in urine)

The ability to measure blood ketones offers a tremendous advantage for people who have a tendency to develop ketoacidosis. For instance, if someone finds his blood sugar unexpectedly high, such as above 300 mg/dl (16.7 mmol), the blood ketone level can be measured immediately on a Precision Xtra™ meter. If ketones are normal, an injection of rapid insulin should correct the problem without any further treatment. But if ketones are present, larger correction boluses and extra attention to increased fluid intake will be necessary.

Remember that urine ketones will always lag behind blood ketone levels. At the start of ketoacidosis, the blood ketone level will be much higher than urine levels, so if your urine ketone test reads “small” but your stomach is upset, be sure to retest in a couple of hours to see if the urine level rises. Measuring ketones in the blood allows them to be detected two to four hours earlier than with urine testing and allows small changes in ketone levels to be monitored rapidly to determine the effectivenss of therapy.

On the other hand, if your urine level has been “high” and you have taken enough fast insulin to bring the blood sugar down toward normal, you should feel better, but your urine ketone level may still read “high” and it may take 8 to 24 hours for the ketones to clear from the urine.

Anyone who has had more than one episode of ketoacidosis should test ketones in the blood. Ketoacidosis can be debilitating, expensive, and frightening. It should always be avoided or treated quickly.