Physical Signs of Diabetic Ketoacidosis (Diabetic Coma)

In this article, we will discuss the Physical Signs of Diabetic Ketoacidosis (Diabetic Coma). So, let’s get started.

Physical Signs

1. There is tachypnea, tachycardia, hypotension, low body temperature and (hypothermia). These are due to fluid and electrolyte disturbance (acidosis) which stimulates the respiratory center (tachypnea) and causes vasodilation (tachycardia) and hypothermia (low body temperature).

2. Signs of dehydration (e.g. dry tongue, mucus membrane and skin, soft eyeballs, sunken cheeks) and hypotension or shock (cold clammy skin, oliguria and obtunded consciousness).

3. Kussumaul breathing, a deep and rapid respiration is due to metabolic acidosis.

4. Acetone smell (like ‘pear drops’ or nail varnish remover) is due to hyperketonemia.

5. There may be hypotonia, hyperreflexia and incoordinated ocular movements.

6. Abdominal tenderness (may resemble acute pancreatitis or surgical abdomen)

7. Obtunded consciousness, cerebral edema stupid or coma. The deterioration of consciousness is proportional to fall in pH and plasma osmolarity. Plasma osmolarity is calculated as:

Calculated osmolarity = 2Na+ + Glu/18 + BUN/ 2.8

The normal osmolarity is 280-300 mOsm/kg.

The level of consciousness depending on plasma hospitality and pH is as follows:


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