Diabetic ketoacidosis
Summary
定义
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].
病史和体格检查
危险因素
- 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
诊断性检查
治疗流程
撰稿人
专家顾问
Aidar R. Gosmanov, MD, PhD, FACE
Associate Professor of Medicine
Division of Endocrinology
Albany Medical College
Chief, Endocrinology Section
Albany VAMC
Albany
NY
利益声明
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
利益声明
LRN declares that she has no competing interests.
鸣谢
Dr Aidar Gosmanov and Dr Laleh Razavi Nematollahi would like to gratefully acknowledge Professor Abbas E. Kitabchi, the previous contributor to this topic.
利益声明
AEK is an author of a number of references in this topic.
同行评议者
David Jenkins, DM, FRCP
Consultant Physician
Worcestershire Royal Hospital
Worcester
UK
利益声明
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
利益声明
UMK declares that she has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
参考文献
关键文献
Umpierrez GE, Davis GM, ElSayed NA, et al. Hyperglycaemic crises in adults with diabetes: a consensus report. Diabetologia. 2024 Aug;67(8):1455-79.全文 摘要
American Diabetes Association. Standards of care in diabetes - 2025. Diabetes Care. 2025 Jan;48(suppl 1):S1-352.全文
Dhatariya KK, Glaser NS, Codner E, et al. Diabetic ketoacidosis. Nat Rev Dis Primers. 2020 May 14;6(1):40. 摘要
Umpierrez G, Korytkowski M. Diabetic emergencies - ketoacidosis, hyperglycaemic hyperosmolar state and hypoglycaemia. Nat Rev Endocrinol. 2016 Apr;12(4):222-32. 摘要
参考文献
A full list of sources referenced in this topic is available here.
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