Summary
Definition
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.[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
Other diagnostic factors
- polyuria
- polyphagia
- polydipsia
- weight loss
- weakness
- nausea or vomiting
- abdominal pain
- dry mucous membranes
- poor skin turgor
- sunken eyes
- tachycardia
- hypotension
- Kussmaul respiration
- acetone breath
- altered mental status
- hypothermia
Risk factors
- inadequate or inappropriate insulin therapy
- infection
- myocardial infarction
- pancreatitis
- stroke
- acromegaly
- hyperthyroidism
- use of certain drugs
- Cushing syndrome
- Hispanic, Asian or black ancestry
- bariatric surgery
- prolonged fasting or carbohydrate restriction
- pregnancy
- dementia
Diagnostic tests
1st tests to order
- plasma glucose
- ABG
- capillary or serum ketones
- urinalysis
- serum BUN
- serum creatinine
- serum sodium
- serum potassium
- serum chloride
- serum magnesium
- serum calcium
- serum phosphate
- anion gap calculation
- serum creatine phosphokinase
- serum lactate
- LFT
- serum amylase
- serum lipase
- serum osmolality
- CBC
Treatment algorithm
Contributors
Authors
Aidar R. Gosmanov, MD, PhD, FACE
Associate Professor of Medicine
Division of Endocrinology
Albany Medical College
Chief, Endocrinology Section
Albany VAMC
Albany
NY
Disclosures
ARG declares that he has no competing interests.
Laleh Razavi Nematollahi, MD
Assistant Professor of Medicine
Case Western Reserve University
Cleveland
OH
Disclosures
LRN declares that she has no competing interests.
Acknowledgements
Dr Aidar Gosmanov and Dr Laleh Razavi Nematollahi would like to gratefully acknowledge Professor Abbas E. Kitabchi, the previous contributor to this topic.
Disclosures
AEK is an author of a number of references in this topic.
Peer reviewers
David Jenkins, DM, FRCP
Consultant Physician
Worcestershire Royal Hospital
Worcester
UK
Disclosures
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
Disclosures
UMK declares that she has no competing interests.
References
Key articles
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.Full text Abstract
American Diabetes Association. Standards of care in diabetes - 2024. Diabetes Care. 2024 Jan 1;47(Suppl 1):S1-321.Full text
Umpierrez G, Korytkowski M. Diabetic emergencies - ketoacidosis, hyperglycaemic hyperosmolar state and hypoglycaemia. Nat Rev Endocrinol. 2016 Apr;12(4):222-32. Abstract
Reference articles
A full list of sources referenced in this topic is available here.
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