Diabetic ketoacidosis is characterised by a biochemical triad of hyperglycaemia, ketonaemia, and metabolic acidosis, with rapid symptom onset.
Common symptoms and signs include increased thirst, polyuria, weight loss, excessive tiredness, nausea, vomiting, dehydration, abdominal pain, hyperventilation, and reduced consciousness.
Successful treatment includes correction of volume depletion, ketogenesis, hyperglycaemia, electrolyte imbalances, and comorbid precipitating events, with frequent monitoring.
Complications of treatment include hypoglycaemia, hypokalaemia, pulmonary oedema, and acute respiratory distress syndrome (ARDS).
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 SGLT2 inhibitors)
- Cushing's syndrome
- Hispanic or black ancestry
- bariatric surgery
Gerry Rayman, MD, FRCP
Consultant Physician and Head of Service
Diabetes and Endocrine Centre and the Diabetes Research Unit
Ipswich Hospitals NHS Trust
GR is Lead and Innovator of the National Inpatient Diabetes Audit; and Joint Clinical Lead of the Diabetes, Getting It Right First Time programme.
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.
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
Laleh Razavi Nematollahi, MD
Assistant Professor of Medicine
Case Western Reserve University
ARG and LRN declare that they have no competing interests.
Honorary Professor of Medicine
University of Manchester
Tameside and Glossop Integrated Care NHS Foundation Trust
EJ declares that he has no competing interests.
Section Editor, BMJ Best Practice
AS declares that she has no competing interests.
Head of Research and Development, BMJ
LD declares that she has no competing interests.
Head of Editorial, BMJ Best Practice
AE declares that she has no competing interests.
Lead Section Editor, BMJ Best Practice
RW declares that she has no competing interests.
Comorbidities Editor, BMJ Best Practice
JC declares that she has no competing interests.
Drug Editor, BMJ Best Practice
AM declares that he has no competing interests.
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