Editing Diabetic ketoacidosis (section)

==Signs and symptoms==
The symptoms of an episode of diabetic ketoacidosis usually evolve over a period of about 24 hours. Predominant symptoms are [[nausea]] and vomiting, pronounced thirst, [[polyuria|excessive urine production]] and [[abdominal pain]] that may be severe.<ref>{{Cite web |title=Diabetic ketoacidosis: Know the warning signs-Diabetic ketoacidosis - Symptoms & causes |url=https://www.mayoclinic.org/diseases-conditions/diabetic-ketoacidosis/symptoms-causes/syc-20371551 |access-date=2024-04-27 |website=Mayo Clinic |language=en}}</ref><ref>{{Cite journal |date=August 9, 2023 |title=Diabetic Ketoacidosis (DKA) |url=https://www.diabetesdaily.com/learn-about-diabetes/complications/diabetes-complications/diabetic-ketoacidosis-dka/ |website=diabetesdaily.com}}</ref> In severe DKA, breathing becomes rapid and of a deep, gasping character, called "[[Kussmaul breathing]]".<ref name=NelsonEss7e>{{cite book | chapter = Diabetes Melitus | veditors = Marcdante KJ, Kliegman R, Nelson WD |title=Nelson Essentials of Pediatrics|date=2015|isbn=978-1-4557-5980-4|pages=573–576|edition=7th| vauthors = Marcdante KJ, Kliegman R | publisher = Elsevier/Saunders }}</ref><ref name=Powers2005>{{cite book | vauthors = Powers AC |veditors= Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL|title=Harrison's Principles of Internal Medicine|edition=16th |year=2005 |publisher=McGraw-Hill |location=New York, NY |isbn=978-0-07-139140-5 |pages=2152–2180 }}</ref> The abdomen may be tender to the point that a [[acute abdomen|serious abdominal condition]] may be suspected, such as [[acute pancreatitis]], [[appendicitis]] or [[gastrointestinal perforation]].<ref name=Powers2005/> [[Coffee ground vomiting|Vomiting altered blood that resembles coffee grounds]] occurs in a minority of people and tends to originate from erosion of the [[esophagus]].<ref name=Eledrisi/> In severe DKA, there may be confusion or a marked decrease in [[level of consciousness|alertness]], including [[coma]].<ref name=JBDS>{{cite web | author=Joint British Diabetes Societies Inpatient Care Group | title=The Management of Diabetic Ketoacidosis in Adults | date=June 2021 | url=https://abcd.care/resource/management-diabetic-ketoacidosis-dka-adults | publisher=Association of British Clinical Diabetologists | access-date=10 August 2021 | archive-date=9 December 2021 | archive-url=https://web.archive.org/web/20211209064832/https://abcd.care/resource/management-diabetic-ketoacidosis-dka-adults | url-status=dead }}</ref><ref name=Powers2005/>

On [[physical examination]] there is usually clinical evidence of [[dehydration]], such as a dry mouth and decreased [[skin turgor]].<ref>{{Cite web |title=Skin turgor: MedlinePlus Medical Encyclopedia |url=https://medlineplus.gov/ency/article/003281.htm |access-date=2024-04-27 |website=medlineplus.gov |language=en}}</ref> If the dehydration is profound enough to cause a decrease in the circulating blood volume, a [[tachycardia|rapid heart rate]] and [[hypotension|low blood pressure]] may be observed. Often, a "ketotic" odor is present, which is often described as "fruity" or "like [[pear drops]]".<ref name="BMJ2015" /><ref name="Powers2005" /> The smell is due to the presence of [[acetone]].<ref>{{cite book | vauthors = Elzouki AY, Harfi HA, Nazer H, Oh W, Stapleton FB, Whitley RJ |title=Textbook of Clinical Pediatrics |date=2011 |publisher=Springer Science & Business Media |isbn=9783642022012 |page=2567 |url=https://books.google.com/books?id=FEf4EMjYSrgC&pg=PA2567 |language=en}}</ref> If Kussmaul respiration is present, this is reflected in an [[tachypnea|increased respiratory rate]].<ref name=Powers2005/>

Small children with DKA are relatively prone to [[cerebral edema|brain swelling]], also called cerebral edema, which may cause headache, coma, loss of the [[pupillary light reflex]], and can progress to death.<ref>{{Cite journal |date=April 25, 2023 |title=Brain injury in children with diabetic ketoacidosis: Review of the literature and a proposed pathophysiologic pathway for the development of cerebral edema |journal= Pediatric Diabetes|pmc=10127934 |volume=22 |issue=2 |pages=148–160 |doi=10.1111/pedi.13152 |pmid=33197066 | vauthors = Azova S, Rapaport R, Wolfsdorf J }}</ref> It occurs in about 1 out of 100 children with DKA and more rarely occurs in adults.<ref name=ADA2009/><ref name=Powers2005/><ref name=Glaser2006>{{cite journal | vauthors = Glaser N | title = New perspectives on the pathogenesis of cerebral edema complicating diabetic ketoacidosis in children | journal = Pediatric Endocrinology Reviews | volume = 3 | issue = 4 | pages = 379–386 | date = June 2006 | pmid = 16816806 }}</ref>