Ketoacidosis is a life-threatening metabolic disorder in which the body breaks down fats and forms ketone bodies due to a severe insulin deficiency. This leads to acidosis of the blood (acidosis). Diabetic ketoacidosis (DKA) occurs primarily in type 1 diabetes, but can also occur in type 2 diabetes.
Causes
The most common triggers are:
- Insulin deficiency or lack of insulin administration in type 1 diabetes
- Infections (e.g. urinary tract infections, pneumonia)
- Stress, surgery or trauma
- New diagnosis of type 1 diabetes
- Pump error or clogged insulin pump
Symptoms
Typical warning signs of ketoacidosis are:
- Nausea, vomiting and abdominal pain
- Fruity breath smell (acetone smell)
- Deep, rapid breathing (Kussmaul breathing)
- Severe tiredness to the point of clouding of consciousness
- Severe thirst and frequent urination
Diagnostics
| Parameters | Typical finding in ketoacidosis |
|---|---|
| blood sugar | usually > 250 mg/dl |
| Ketone bodies (blood or urine) | strongly increased (β-hydroxybutyrate > 3 mmol/l) |
| Blood pH | < 7.3 (acidosis) |
| Bicarbonate | <15 mmol/l |
Therapy
Ketoacidosis is an **emergency** and requires immediate hospitalization:
- Intravenous fluid administration
- Insulin by infusion
- Balancing the electrolyte balance (especially potassium)
- Treatment of the cause (e.g. infection)
Further information:
→ Diabetes mellitus – knowledge and overview
→ Why hyporest
→ Hyperglycemia
Sources
- German Diabetes Society (DDG). S3 guideline “Diabetes mellitus type 1 and type 2”. As of 2025. Available at: www.deutsche-diabetes-gesellschaft.de/leitlinien.
- American Diabetes Association. Standards of Medical Care in Diabetes—2026. Diabetes Care. 2026;49(Suppl 1). Available at: diabetesjournals.org.
- Robert Koch Institute (RKI). Federal health reporting – diabetes mellitus in Germany. Berlin 2024.
- International Diabetes Federation (IDF). IDF Diabetes Atlas. 11th edition. Brussels 2025. Available at: diabetesatlas.org.
Important note:
The information in this encyclopedia article is intended solely for general and non-binding information. They do not replace medical advice, diagnosis or therapy. If you have any health questions or complaints, please always consult a doctor or qualified healthcare professional. The content was created with the greatest possible care, but errors cannot be completely ruled out.
Last updated: February 26, 2026
