Clinical Manifestations

Fig 3: Young people presenting to the ED with DKA will appear unwell

The clinical manifestations of DKA include [25]:

• Dehydration
• Kussmaul respiration (deep, rapid, sighing)
• Nausea and vomiting
• Abdominal pain (can mimic an acute abdomen)
• Progressive clouding of consciousness and coma
• Increased leukocyte count with left shift (does not necessarily indicate sepsis)
• Non-specific elevation of serum amylase
• Ketotic breath
• Increased heart rate

Fever is not a feature of DKA.  Think about sepsis in a child or young person with DKA who has any of the following:

• fever or hypothermia
• hypotension
• refractory acidosis
• lactic acidosis