Diabetic ketoacidosis is characterised by a biochemical triad of hyperglycaemia, ketonaemia, and acidaemia, with rapid symptom onset.
Common symptoms and signs include polyuria, polydipsia, polyphagia, weakness, weight loss, tachycardia, dry mucous membranes, poor skin turgor, hypotension, and, in severe cases, shock.
Successful treatment includes correction of volume depletion, hyperglycaemia, electrolyte imbalances, and comorbid precipitating events, with frequent monitoring.
Complications of treatment include hypoglycaemia, hypokalaemia, hypoxaemia, and rarely pulmonary oedema.
Cerebral oedema, a rare but potentially rapidly fatal complication, occurs mainly in children. It may be prevented by avoiding overly rapid fluid and electrolyte replacement.
Diabetic ketoacidosis (DKA) is an acute metabolic complication of diabetes that is potentially fatal and requires prompt medical attention for successful treatment. It is characterised by absolute insulin deficiency and is the most common acute hyperglycaemic complication of type 1 diabetes mellitus.
History and exam
- inadequate or inappropriate insulin therapy
- myocardial infarction
- drugs (e.g., corticosteroids, thiazides, pentamidine, sympathomimetics, second-generation antipsychotics, cocaine, immune checkpoint inhibitors, or SGLT-2 inhibitors)
- Cushing's syndrome
- Hispanic or black ancestry
- bariatric surgery
- plasma glucose
- capillary or serum ketones
- serum urea
- serum creatinine
- serum sodium
- serum potassium
- serum chloride
- serum magnesium
- serum calcium
- serum phosphate
- anion gap calculation
- serum creatine phosphokinase
- serum lactate
- serum amylase
- serum lipase
- serum osmolality
Associate Professor of Medicine
Division of Endocrinology
Albany Medical College
Chief, Endocrinology Section
ARG declares that he has no competing interests.
Assistant Professor of Medicine
Case Western Reserve University
LRN declares that she has no competing interests.
Dr Aidar Gosmanov and Dr Laleh Razavi Nematollahi would like to gratefully acknowledge Professor Abbas E. Kitabchi, the previous contributor to this topic.
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