Diabetic ketoacidosis
Summary
Definition
DKA is an acute metabolic complication of diabetes that is potentially fatal and requires prompt medical attention for successful treatment. It is characterized by absolute (total absence of) or relative (levels insufficient to suppress gluconeogenesis and ketone production) insulin deficiency and elevation of counter-regulatory hormones (glucagon, epinephrine, norepinephrine, cortisol, and growth hormone).[1] It is the most common acute hyperglycemic complication of type 1 diabetes mellitus.[1] While most cases occur in patients with type 1 diabetes, DKA can also affect patients with type 2 diabetes.
This topic covers DKA in adults.
[Figure caption and citation for the preceding image starts]: Triad of DKAAdapted with permission from: Kitabchi AE, Wall BM. Diabetic ketoacidosis. Med Clin North Am. 1995;79:9-37 [Citation ends].
History and exam
Other diagnostic factors
- polyuria
- polyphagia
- polydipsia
- weight loss
- weakness
- nausea or vomiting
- abdominal pain
- dry mucous membranes
- poor skin turgor
- sunken eyes
- tachycardia
- hypotension
- Kussmaul respiration
- acetone breath
- altered mental status
- hypothermia
Risk factors
- type 1 diabetes
- inadequate or inappropriate insulin therapy
- infection
- myocardial infarction
- previous episode of hyperglycemic or hypoglycemic crisis
- high hemoglobin A1c (HbA1c)
- adverse social determinants of health
- age <45 years
- presence of other diabetes-related complications
- presence of other chronic health conditions
- pancreatitis
- stroke
- acromegaly
- hyperthyroidism
- use of certain drugs
- Cushing syndrome
- Hispanic, Asian, or black ancestry
- bariatric surgery
- prolonged fasting or carbohydrate restriction
- pregnancy
- dementia
- mental health disorders
- alcohol and/or substance use
Diagnostic investigations
1st investigations to order
- plasma glucose
- ABG
- capillary or serum ketones
- urinalysis
- serum BUN
- serum creatinine
- serum sodium
- serum potassium
- serum chloride
- serum magnesium
- serum phosphate
- anion gap calculation
- serum lactate
- LFT
- serum amylase
- serum lipase
- serum osmolality
- CBC
- ECG
Investigations to consider
- serum creatine kinase (CK)
- CXR
- high-sensitivity cardiac troponin
- blood, urine, or sputum cultures
Treatment algorithm
Contributors
Expert advisers
Aidar R. Gosmanov, MD, PhD, FACE
Associate Professor of Medicine
Division of Endocrinology
Albany Medical College
Chief, Endocrinology Section
Albany VAMC
Albany, NY
Disclosures
ARG declares that he has no competing interests.
Laleh Razavi Nematollahi, MD
Assistant Professor of Medicine
Cleveland Clinic Lerner College of Medicine
Case Western Reserve University
Cleveland, OH
გაფრთხილება:
LRN declares that she has no competing interests.
მადლიერება
Dr Aidar Gosmanov and Dr Laleh Razavi Nematollahi would like to gratefully acknowledge Professor Abbas E. Kitabchi, the previous contributor to this topic.
გაფრთხილება:
AEK is an author of a number of references in this topic.
რეცენზენტები
David Jenkins, DM, FRCP
Consultant Physician
Worcestershire Royal Hospital
Worcester
UK
გაფრთხილება:
DJ declares that he has no competing interests.
Udaya M. Kabadi, MD, FRCP(C), FACP, FACE
Professor of Medicine
University of Iowa
Iowa City, IA
გაფრთხილება:
UMK declares that she has no competing interests.
რეცენზენტების განცხადებები
BMJ Best Practice-ის თემების განახლება სხვადასხვა პერიოდულობით ხდება მტკიცებულებებისა და რეკომენდაციების განვითარების შესაბამისად. ქვემოთ ჩამოთვლილმა რეცენზენტებმა თემის არსებობის მანძილზე კონტენტს ერთხელ მაინც გადახედეს.
გაფრთხილება
რეცენზენტების აფილიაციები და გაფრთხილებები მოცემულია გადახედვის მომენტისთვის.
წყაროები
ძირითადი სტატიები
Umpierrez GE, Davis GM, ElSayed NA, et al. Hyperglycaemic crises in adults with diabetes: a consensus report. Diabetologia. 2024 Aug;67(8):1455-79.სრული ტექსტი აბსტრაქტი
American Diabetes Association. Standards of care in diabetes - 2025. Diabetes Care. 2025 Jan;48(suppl 1):S1-352.სრული ტექსტი
Dhatariya KK, Glaser NS, Codner E, et al. Diabetic ketoacidosis. Nat Rev Dis Primers. 2020 May 14;6(1):40. აბსტრაქტი
Umpierrez G, Korytkowski M. Diabetic emergencies - ketoacidosis, hyperglycaemic hyperosmolar state and hypoglycaemia. Nat Rev Endocrinol. 2016 Apr;12(4):222-32. აბსტრაქტი
გამოყენებული სტატიები
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