Summary
Definition
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.[1]
[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
Key diagnostic factors
- known diabetes or features of diabetes
- nausea and/or vomiting
- abdominal pain
- dehydration
- hyperventilation
- reduced consciousness
- risk factors
- hypothermia
Risk factors
- inadequate or inappropriate insulin therapy
- infection
- myocardial infarction
- pancreatitis
- stroke
- acromegaly
- hyperthyroidism
- drugs (e.g., corticosteroids, thiazides, pentamidine, sympathomimetics, second-generation antipsychotics, cocaine, immune checkpoint inhibitors, or SGLT2 inhibitors)
- Cushing's syndrome
- Hispanic or black ancestry
- bariatric surgery
Diagnostic investigations
1st investigations to order
- venous blood gas
- blood ketones
- blood glucose
- urea and electrolytes
- full blood count
Investigations to consider
- urinalysis
- ECG
- pregnancy test
- amylase and lipase
- cardiac enzymes
- creatinine kinase
- chest x-ray
- liver function tests
- blood, urine, and sputum cultures
Treatment algorithm
Contributors
Expert advisers
Gerry Rayman, MD, FRCP
Consultant Physician and Head of Service
Diabetes and Endocrine Centre and the Diabetes Research Unit
Ipswich Hospitals NHS Trust
Ipswich
UK
Biography
GR is Lead and Innovator of the National Inpatient Diabetes Audit; and Joint Clinical Lead of the Diabetes, Getting It Right First Time programme.
Disclosures
GR has been paid for advisory board meetings with the following companies: Sanofi Aventis, Abbott Diabetes UK, Lilly Diabetes, and Bayer. GR has received lecture fees from Sanofi Aventis, Abbott Diabetes UK, Lilly Diabetes, Novo Nordisk, and Napp Pharmaceuticals Ltd.
Acknowledgements,
BMJ Best Practice would like to gratefully acknowledge the previous team of expert contributors, whose work has been retained in parts of the content:
Aidar R. Gosmanov, MD, PhD, FACE
Associate Professor of Medicine
Division of Endocrinology
Albany Medical College
Chief, Endocrinology Section
Albany VAMC
Albany
NY
Laleh Razavi Nematollahi, MD
Assistant Professor of Medicine
Case Western Reserve University
Cleveland
OH
Disclosures
ARG and LRN declare that they have no competing interests.
Peer reviewers
Edward Jude,
Honorary Professor of Medicine
University of Manchester
Consultant Physician/Diabetologist/Endocrinologist
Tameside and Glossop Integrated Care NHS Foundation Trust
Manchester
UK
Disclosures
EJ declares that he has no competing interests.
Editors
Annabel Sidwell,
Section Editor, BMJ Best Practice
Disclosures
AS declares that she has no competing interests.
Luisa Dillner,
Head of Research and Development, BMJ
Disclosures
LD declares that she has no competing interests.
Anna Ellis,
Head of Editorial, BMJ Best Practice
Disclosures
AE declares that she has no competing interests.
Rachel Wheeler,
Lead Section Editor, BMJ Best Practice
Disclosures
RW declares that she has no competing interests.
Julie Costello,
Comorbidities Editor, BMJ Best Practice
Disclosures
JC declares that she has no competing interests.
Adam Mitchell,
Drug Editor, BMJ Best Practice
Disclosures
AM declares that he has no competing interests.
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