Last reviewed:October 2019
Last updated:April  2018



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
  • MI
  • pancreatitis
  • stroke
  • acromegaly
  • hyperthyroidism
  • drugs such as corticosteroids, thiazides, pentamidine, sympathomimetics, second-generation antipsychotics, cocaine, immune checkpoint inhibitors, or SGLT2 inhibitors
  • Cushing syndrome
  • Hispanic or black ancestry
  • bariatric surgery

Diagnostic investigations

1st investigations to order

  • plasma glucose
  • ABG
  • capillary or serum ketones
  • U/A
  • 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
Full details

Investigations to consider

  • chest x-ray
  • ECG
  • cardiac biomarkers
  • blood, urine, or sputum cultures
Full details

Treatment algorithm


Associate Professor of Medicine

Division of Endocrinology

Albany Medical College


Chief, Endocrinology Section

Albany VAMC




ARG declares that he has no competing interests.

Dr Aidar Gosmanov would like to gratefully acknowledge Professor Abbas E. Kitabchi and Dr Laleh Razavi Nematollahi, the previous contributors to this topic. AEK is an author of a number of references in this topic and LRN declares that she has no competing interests.

Peer reviewersVIEW ALL

Consultant Physician

Worcestershire Royal Hospital




DJ declares that he has no competing interests.

Professor of Medicine

University of Iowa

Iowa City



UMK declares that she has no competing interests.

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