Early Detection of Diabetic Ketoacidosis by Breathalyzer in a Sailor Reporting for Duty

Abstract

Diabetic ketoacidosis (DKA) is a severe medical condition involving the uncontrolled hyperglycemia and ketoacidosis that results from impaired insulin utilization. The biochemical response to insulin resistance or deficiency is a ketotic state in which fatty acids are converted to ketone bodies for an alternative energy source. Patients in DKA acutely develop severe symptoms, typically over the course of 24–48 hours. Classic symptoms include nausea, vomiting, lethargy, altered mental status, and abdominal pain. As the time course of ketoacidosis is relatively rapid, it is rare to identify a developing case of DKA prior to symptom onset. In this atypical case, the author presents an asymptomatic 37-year-old active duty male without a history of diabetes, whose DKA detection was inspired by an elevated breathalyzer reading. The Sailor underwent routine breath alcohol analysis per command instruction upon reporting for duty. In the absence of recent alcohol intake, the elevated breathalyzer reading is associated with the Sailor’s metabolic ketoacidosis. Acetone, one of three primary ketone bodies generated in DKA is notable as the cause of the hallmark fruity odor breath of DKA patients. In this case, it is converted to isopropanol, an agent that is detectable by breathalyzers.

Breath Analysis for the In Vivo Detection of Diabetic Ketoacidosis

“…The “fruity odor” of ketones on a patient’s breath with ketoacidosis has been used clinically for many years. , However, accurate quantitative breath analysis may enable rapid, noninvasive, and repeatable monitoring of ketoacidosis . An acetone breath concentration of <0.9 ppm is normal, and a concentration >1.7 ppm indicates ketoacidosis. , …”