Patients with known diabetes who are unwell[2]Joint British Diabetes Societies for Inpatient Care. The management of diabetic ketoacidosis in adults. Mar 2023 [internet publication].
https://abcd.care/sites/abcd.care/files/site_uploads/JBDS_Guidelines_Current/JBDS_02_DKA_Guideline_with_QR_code_March_2023.pdf
[4]Misra S, Oliver NS. Diabetic ketoacidosis in adults. BMJ. 2015 Oct 28;351:h5660.
http://www.ncbi.nlm.nih.gov/pubmed/26510442?tool=bestpractice.com
[17]Karslioglu French E, Donihi AC, Korytkowski MT. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome: review of acute decompensated diabetes in adult patients. BMJ. 2019 May 29;365:l1114.
https://www.doi.org/10.1136/bmj.l1114
http://www.ncbi.nlm.nih.gov/pubmed/31142480?tool=bestpractice.com
DKA is most common in people with type 1 diabetes but can also present in those with type 2 diabetes.[1]Kitabchi AE, Umpierrez GE, Miles JM, et al. Hyperglycemic crises in adult patients with diabetes: a consensus statement from the American Diabetes Association. Diabetes Care. 2009 Jul;32(7):1335-43.
http://care.diabetesjournals.org/content/32/7/1335.full
http://www.ncbi.nlm.nih.gov/pubmed/19564476?tool=bestpractice.com
[2]Joint British Diabetes Societies for Inpatient Care. The management of diabetic ketoacidosis in adults. Mar 2023 [internet publication].
https://abcd.care/sites/abcd.care/files/site_uploads/JBDS_Guidelines_Current/JBDS_02_DKA_Guideline_with_QR_code_March_2023.pdf
Any patient with increased thirst, polyuria, recent unexplained weight loss or excessive tiredness, AND any of the following:[17]Karslioglu French E, Donihi AC, Korytkowski MT. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome: review of acute decompensated diabetes in adult patients. BMJ. 2019 May 29;365:l1114.
https://www.doi.org/10.1136/bmj.l1114
http://www.ncbi.nlm.nih.gov/pubmed/31142480?tool=bestpractice.com
[43]National Institute for Health and Care Excellence. Type 1 diabetes in adults: diagnosis and management. Aug 2022 [internet publication].
https://www.nice.org.uk/guidance/ng17
[48]National Institute for Health and Care Excellence. Diabetes (type 1 and type 2) in children and young people: diagnosis and management. Jun 2022 [internet publication].
https://www.nice.org.uk/guidance/ng18
http://www.ncbi.nlm.nih.gov/pubmed/32200593?tool=bestpractice.com
Nausea
Vomiting
Abdominal pain[4]Misra S, Oliver NS. Diabetic ketoacidosis in adults. BMJ. 2015 Oct 28;351:h5660.
http://www.ncbi.nlm.nih.gov/pubmed/26510442?tool=bestpractice.com
[49]Umpierrez G, Freire AX. Abdominal pain in patients with hyperglycemic crises. J Crit Care. 2002 Mar;17(1):63-7.
http://www.ncbi.nlm.nih.gov/pubmed/12040551?tool=bestpractice.com
Hyperventilation (Kussmaul’s respiration)[50]Whited L, Graham DD. Abnormal respirations. In: StatPearls. Treasure Island, FL: StatPearls Publishing; 2019.
https://www.ncbi.nlm.nih.gov/books/NBK470309
Dehydration
Reduced consciousness.
Urgently order a venous blood gas, blood ketones, and capillary blood glucose.