Editing Diabetic coma (section)

===Advanced diabetic ketoacidosis===
[[Diabetic ketoacidosis]] (DKA), most typically seen in those with type 1 diabetes, is triggered by the build-up of chemicals called ketones. These are strongly acidic and a build-up can cause the blood to become acidic.<ref name=":0" /> When these levels get too high it essentially poisons the body and causes DKA.<ref>{{Cite web|title=DKA (Ketoacidosis) & Ketones {{!}} ADA|url=https://www.diabetes.org/diabetes/complications/dka-ketoacidosis-ketones|access-date=2021-12-27|website=www.diabetes.org}}</ref>

If it progresses and worsens without treatment it can eventually cause unconsciousness, from a combination of a very high [[blood sugar]] level, [[dehydration]] and [[shock (circulatory)|shock]], and exhaustion. Coma only occurs at an advanced stage, usually after 36 hours or more of worsening [[vomiting]] and [[hyperventilation]].

In the early to middle stages of ketoacidosis, patients are typically flushed and breathing rapidly and deeply, but visible dehydration, [[pallor|pale appearance]] from diminished perfusion, shallower breathing, and a [[tachycardia|fast heart rate]] are often present when coma is reached. However these features are variable and not always as described.

If the patient is known to have diabetes, the diagnosis of diabetic ketoacidosis is usually suspected from the appearance and a history of 1–2 days of vomiting. The diagnosis is confirmed when the usual blood chemistries in the emergency department reveal a high blood sugar level and severe [[metabolic acidosis]].

Treatment of diabetic ketoacidosis consists of isotonic fluids to rapidly stabilize the circulation, continued intravenous [[saline (medicine)|saline]] with [[potassium]] and other electrolytes to replace deficits, insulin to reverse the ketoacidosis, and careful monitoring for complications.