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Last reviewed: 13 Jan 2026
Last updated: 17 Dec 2025

Summary

Definition

History and exam

Key diagnostic factors

  • diabetes conhecido ou características do diabetes
  • náuseas e/ou vômitos
  • dor abdominal
  • desidratação
  • hiperventilação (respiração de Kussmaul)
  • nível de consciência reduzido
  • presença de fatores de risco
  • hipotermia
Full details

Other diagnostic factors

  • hálito cetônico
Full details

Risk factors

  • diabetes do tipo 1
  • insulinoterapia inadequada ou inapropriada
  • infecção
  • infarto do miocárdio
  • episódio anterior de hipoglicemia ou crise hipoglicêmica
  • HbA1c elevada
  • determinantes sociais adversos da saúde
  • Idade <45 anos
  • presença de outras complicações relacionadas à diabetes
  • presença de outras condições crônicas de saúde
  • pancreatite
  • acidente vascular cerebral (AVC)
  • acromegalia
  • hipertireoidismo
  • uso de determinados medicamentos
  • Síndrome de Cushing
  • Ascendência hispânica, asiática ou negra
  • cirurgia bariátrica
  • jejum prolongado ou restrição de carboidratos
  • gestação
  • uso de álcool e/ou substâncias
  • demência
  • transtornos de saúde mental
Full details

Diagnostic investigations

1st investigations to order

  • gasometria venosa
  • cetonas sanguíneas
  • glicose sanguínea
  • ureia e eletrólitos
  • hemograma completo
Full details

Investigations to consider

  • urinálise
  • eletrocardiograma (ECG)
  • teste de gravidez
  • amilase e lipase
  • enzimas cardíacas
  • creatinina quinase
  • radiografia torácica
  • testes da função hepática
  • culturas de sangue, urina e escarro
Full details

Treatment algorithm

ACUTE

pressão arterial sistólica inicial <90 mmHg

pressão arterial sistólica inicial ≥90 mmHg

Contributors

Expert advisers

Edward Jude, MD, MRCP

Consultant Diabetologist and Endocrinologist

Tameside and Glossop Integrated Care NHS Foundation Trust

Honorary Professor, University of Manchester

Honorary Professor, Manchester Metropolitan University Manchester

Manchester

UK

Disclosures

EJ has received honoraria and travel grants from Novo Nordisk, Sanofi, Lilly, Astra Zeneca, Biocomposites, and Menarini.

Acknowledgements

BMJ Best Practice would like to gratefully acknowledge the previous team of expert contributors, whose work has been retained in parts of the content:

Aidar R. Gosmanov, MD, PhD, FACE

Associate Professor of Medicine

Division of Endocrinology

Albany Medical College

Chief, Endocrinology Section

Albany VAMC

Albany

NY

Laleh Razavi Nematollahi, MD

Assistant Professor of Medicine

Case Western Reserve University

Cleveland

OH

Disclosures

ARG and LRN declare that they have no competing interests.

Peer reviewers

Gerry Rayman, MD, FRCP

Consultant Physician and Head of Service

Diabetes and Endocrine Centre and the Diabetes Research Unit

Ipswich Hospitals NHS Trust

Ipswich

UK

Disclosures

GR has been paid for advisory board meetings with the following companies: Sanofi Aventis, Abbott Diabetes UK, Lilly Diabetes, and Bayer. GR has received lecture fees from Sanofi Aventis, Abbott Diabetes UK, Lilly Diabetes, Novo Nordisk, and Napp Pharmaceuticals Ltd.

Ketan Dhatariya, MBBS, MSc, MD, MS, FRCP, PhD

Honorary Professor of Medicine

Norwich Medical School, University of East Anglia

Consultant Diabetes & Endocrinology

Norfolk and Norwich University Hospitals NHS Foundation Trust

Norwich

UK

Disclosures

KD is the chair of the Joint British Diabetes Societies for Inpatient Care. KD has received honoraria from Diabetes Professional Care to speak at its annual meeting about these guidelines. No other reimbursement has been received from commercial organisations with respect to these guidelines. KD has helped to develop educational materials on this subject for the European Association for the Study of Diabetes, but did not receive any reimbursement. For other work as the chair of JBDS, KD has received honoraria from Lilly for developing educational material.

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.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Umpierrez GE, Davis GM, ElSayed NA, et al. Hyperglycaemic crises in adults with diabetes: a consensus report. Diabetologia. 2024 Aug;67(8):1455-79.Full text  Abstract

Joint British Diabetes Societies for Inpatient Care. The management of diabetic ketoacidosis in adults. Mar 2023 [internet publication].Full text

American Diabetes Association. Standards of care in diabetes -2025. Diabetes Care. 2025 Jan 1;48(Suppl 1): S1-343.Full text

Dhatariya KK, Glaser NS, Codner E, et al. Diabetic ketoacidosis. Nat Rev Dis Primers. 2020 May 14;6(1):40. Abstract

National Institute for Health and Care Excellence. Type 1 diabetes in adults: diagnosis and management. Aug 2022 [internet publication].Full text

Reference articles

A full list of sources referenced in this topic is available here.

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