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