Ketosis-Prone Type 2 Diabetes Clinical Presentation

Updated: Jan 06, 2016
  • Author: Richard S Krause, MD; Chief Editor: George T Griffing, MD  more...
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The presentation of DKA does not differ markedly according to the Aß phenotype. Typical features of polydipsia, polyuria, and fatigue are seen. In patients who already require insulin, the onset of DKA can be rapid when, for example, insulin is abruptly discontinued or a major stressor such as acute myocardial infarction occurs.

Patients with previously undiagnosed ketosis-prone type 2 diabetes may have a less abrupt onset of symptoms. Symptoms related to an underlying precipitating event, such as myocardial infarction or infection (eg, pneumonia, urinary tract infection) may be noted. Abdominal pain is also a common complaint associated with DKA, especially in children. The cause of abdominal pain in DKA is not well understood but appears to relate to the severity of the acidosis. Failure of abdominal pain to resolve with treatment of DKA or marked abdominal tenderness should lead to consideration of other causes. Shortness of breath in spite of normal pulse oximetry and clear lungs is common.


Physical Examination

Physical signs in DKA are associated with the severity of the metabolic derangement and dehydration and may include the following:

  • Tachypnea/hyperpnea

  • Tachycardia

  • Dry mucous membranes

  • Poor skin turgor

  • Altered mental status

  • Nausea, vomiting

  • Hypotension

  • Signs related to a precipitating illness