What are the symptoms of ketoacidosis?
Nov 24, 2025
Source: Cainiu Health
Dr. Wang Lei
Introduction
Ketoacidosis usually refers to diabetic ketoacidosis. Diabetic ketoacidosis is an acute complication of diabetes, often triggered by infections, discontinuation of medication, or poor dietary control. Symptoms progressively worsen from early stages and include worsening of the classic "three more and one less" symptoms (polyuria, polydipsia, polyphagia, and weight loss), gastrointestinal discomfort, abnormal breathing, signs of dehydration, and altered mental status. Patients with diabetes should take medications regularly, maintain proper diet control, and monitor blood glucose levels routinely.
Ketoacidosis usually refers to diabetic ketoacidosis (DKA). Diabetic ketoacidosis is an acute complication of diabetes, commonly triggered by infections, discontinuation of medication, or poor dietary control. Symptoms progressively worsen from the early stage onward and mainly include exacerbation of the "three more and one less" symptoms, gastrointestinal discomfort, abnormal breathing, signs of dehydration, and altered mental status. A detailed analysis is as follows:
1. Worsening of "three more and one less" symptoms: Classic symptoms of diabetes suddenly intensify, particularly excessive thirst and frequent urination. Patients drink more and urinate more often; some may also experience increased appetite, yet body weight rapidly decreases. These changes are closely related to sharply elevated blood glucose levels and metabolic disturbances, with symptoms becoming significantly worse than usual and continuously progressing.
2. Gastrointestinal discomfort: Often misdiagnosed as a gastrointestinal disorder, patients may experience nausea and frequent vomiting, with vomit possibly having a sour or foul odor. Persistent abdominal pain occurs, which may be dull or cramp-like and vary in location. Some individuals also suffer from bloating and loss of appetite. In severe cases, vomiting becomes uncontrollable, impairing nutritional intake.
3. Abnormal breathing: Accumulation of ketones in the body alters respiration. Initially, breathing becomes deep and rapid (Kussmaul breathing); later, a distinctive fruity or "rotten apple" odor on the breath may develop—this is a characteristic sign of ketoacidosis. In severe cases, respiratory rhythm becomes disordered, leading to difficulty breathing, indicating that the condition has progressed to a critical stage.
4. Signs of dehydration: Persistent vomiting and excessive urination lead to fluid loss. Symptoms include dry mouth, decreased skin elasticity (skin that returns slowly after pinching), sunken eyes, reduced urine output, possible drop in blood pressure, rapid heart rate, and signs of inadequate perfusion such as dizziness and fatigue.
5. Altered mental status: Early signs often include lethargy and restlessness, with difficulty concentrating. As the condition worsens, patients may become drowsy or confused. In severe cases, they may fall into a coma, unresponsive to verbal stimuli—this is a key indicator of life-threatening severity.
Patients with diabetes should take medications regularly, maintain proper diet control, and monitor blood glucose levels routinely, while avoiding triggers such as infections. Immediate medical attention is required if any of the above symptoms appear. Maintaining a healthy lifestyle and following medical advice to adjust treatment plans can effectively reduce the risk of developing diabetic ketoacidosis.
