Resumo
Definição
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 (total absence of) or relative (levels insufficient to suppress gluconeogenesis and ketone production) insulin deficiency and elevation of counterregulatory hormones (glucagon, epinephrine, norepinephrine, cortisol, and growth hormone).[1] It is the most common acute hyperglycemic complication of type 1 diabetes mellitus.[1] While most cases occur in patients with type 1 diabetes, DKA can also affect patients with type 2 diabetes.
This topic covers DKA in adults.
[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].
História e exame físico
Outros fatores diagnósticos
- 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
Fatores de risco
- type 1 diabetes
- inadequate or inappropriate insulin therapy
- infection
- myocardial infarction
- previous episode of hyperglycemic or hypoglycemic crisis
- high hemoglobin A1c (HbA1c)
- adverse social determinants of health
- age <45 years
- presence of other diabetes-related complications
- presence of other chronic health conditions
- pancreatitis
- stroke
- acromegaly
- hyperthyroidism
- use of certain drugs
- Cushing syndrome
- Hispanic, Asian or black ancestry
- bariatric surgery
- prolonged fasting or carbohydrate restriction
- pregnancy
- dementia
- mental health disorders
- alcohol and/or substance use
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- plasma glucose
- ABG
- capillary or serum ketones
- urinalysis
- serum BUN
- serum creatinine
- serum sodium
- serum potassium
- serum chloride
- serum magnesium
- serum phosphate
- anion gap calculation
- serum lactate
- LFT
- serum amylase
- serum lipase
- serum osmolality
- CBC
- ECG
Investigações a serem consideradas
- serum creatine kinase (CK)
- CXR
- high sensitivity cardiac troponin
- blood, urine, or sputum cultures
Algoritmo de tratamento
Colaboradores
Autores
Aidar R. Gosmanov, MD, PhD, FACE
Associate Professor of Medicine
Division of Endocrinology
Albany Medical College
Chief, Endocrinology Section
Albany VAMC
Albany
NY
Declarações
ARG declares that he has no competing interests.
Laleh Razavi Nematollahi, MD
Assistant Professor of Medicine
Cleveland Clinic Lerner College of Medicine
Case Western Reserve University
Cleveland
OH
Declarações
LRN declares that she has no competing interests.
Agradecimentos
Dr Aidar Gosmanov and Dr Laleh Razavi Nematollahi would like to gratefully acknowledge Professor Abbas E. Kitabchi, the previous contributor to this topic.
Declarações
AEK is an author of a number of references in this topic.
Revisores
David Jenkins, DM, FRCP
Consultant Physician
Worcestershire Royal Hospital
Worcester
UK
Declarações
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
Declarações
UMK declares that she has no competing interests.
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.
Referências
Principais artigos
Umpierrez GE, Davis GM, ElSayed NA, et al. Hyperglycaemic crises in adults with diabetes: a consensus report. Diabetologia. 2024 Aug;67(8):1455-79.Texto completo Resumo
American Diabetes Association. Standards of care in diabetes - 2025. Diabetes Care. 2025 Jan ;48(suppl 1):S1-352.Texto completo
Dhatariya KK, Glaser NS, Codner E, et al. Diabetic ketoacidosis. Nat Rev Dis Primers. 2020 May 14;6(1):40. Resumo
Umpierrez G, Korytkowski M. Diabetic emergencies - ketoacidosis, hyperglycaemic hyperosmolar state and hypoglycaemia. Nat Rev Endocrinol. 2016 Apr;12(4):222-32. Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível aqui.
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