Table 1.

Symptoms and signs in diabetic ketoacidosis and stroke: overlapping features

DKA	Stroke	Comments
Excessive thirst or drinking lots of fluid	Inability to swallow
Frequent urination	Incontinence	Frequent urination and incontinence may be difficult to differentiate in a somnolent/comatose patient
General weakness	General weakness, a feeling of weakness in one arm/leg
Nausea and vomiting	Nausea and vomiting
Loss of appetite	Loss of appetite	Loss of appetite in DKA results from the predominantly catabolic pattern of metabolism, nausea, and confusion
Confusion, somnolence, stupor, coma	Confusion, somnolence, stupor, coma	Mental status changes can be seen with mild-to-moderate DKA; more severe deterioration in mental status is typical with moderate-to-severe DKA
Headache	Headache
Shortness of breath; increased rate of breathing, Kussmaul type	Increased or decreased breathing frequency; abnormal breathing patterns, Cheyne–Stokes type	Breathing patterns may be similar and interchangeably assigned to either of the diseases
Generally ill appearance	Generally ill appearance
Dry skin	Skin may be dry or moist	Dehydration may occur in case of not having access to water or fluids, or intensive use of osmotic diuretics
Dry mouth	Often dry mouth
Increased heart rate	Increased heart rate
Low blood pressure	Mainly high blood pressure, sometimes low
Distinctive fruity odor on the breath, fruity-scented breath	Different kinds of breath odor not uncommon	Fruity scented breath may be hardly recognizable Moreover, the odor appearing after ingestion of various fruits may imitate the characteristic odor of DKA
High blood sugar level	High sugar level in diabetics	Due to the effect of counterregulatory hormones
High ketone level in serum and urine	Moderately high ketone level in urine in diabetics, alcohol abuse, starvation
Low (<7.3) plasma pH	Serum pH usually normal
Low serum (<15 mmol/L) bicarbonate	Serum pH bicarbonate usually normal
Increased (>12) anion gap	Anion gap usually >12

Abbreviation: DKA, diabetic ketoacidosis.