Diabetic ketoacidosis is characterized by a biochemical triad of hyperglycemia, ketonemia, and acidemia, 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, hyperglycemia, electrolyte imbalances, and comorbid precipitating events, with frequent monitoring.
Complications of treatment include hypoglycemia, hypokalemia, hypoxemia, and rarely pulmonary edema.
Cerebral edema, 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 characterized by absolute insulin deficiency and is the most common acute hyperglycemic 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 syndrome
- Hispanic or black ancestry
- bariatric surgery
- plasma glucose
- capillary or serum ketones
- serum BUN
- 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
Aidar R. Gosmanov, MD, PhD, FACE
Associate Professor of Medicine
Division of Endocrinology
Albany Medical College
Chief, Endocrinology Section
ARG declares that he has no competing interests.
Laleh Razavi Nematollahi, MD
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.
AEK is an author of a number of references in this topic.
David Jenkins, DM, FRCP
Worcestershire Royal Hospital
DJ declares that he has no competing interests.
Udaya M. Kabadi, MD, FRCP(C), FACP, FACE
Professor of Medicine
University of Iowa
UMK declares that she has no competing interests.
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