Home

Search

Pathway AI

Account ⋅ Sign Out

Table of contents

Diabetic ketoacidosis

Definition
DKA is an acute metabolic complication of diabetes characterized by a triad of hyperglycemia, ketosis, and acidemia.
1
Pathophysiology
DKA is caused by inadequate insulin therapy in hospital, new diagnosis of T1DM mellitus, poor concordance with insulin treatment, infection (commonly chest, urinary tract, skin), and acute coronary/vascular event.
2
Disease course
Clinical manifestations include nausea, vomiting, abdominal pain, weakness, polydipsia, polyuria, dehydration, fruity odor of breath, rapid shallow Kussmaul breathing, hypotension, and altered sensorium. Delay in hospitalization, acidosis severity, and peripheral vascular insufficiency are associated with increased mortality.
1
Prognosis and risk of recurrence
The overall mortality rate of DKA is around 10%.
1
Key sources
The following summarized guidelines for the evaluation and management of diabetic ketoacidosis are prepared by our editorial team based on guidelines from the American Diabetes Association (ADA 2023), the United Kingdom Kidney Association (UKKA 2021), the Kidney Disease: Improving Global Outcomes Foundation (KDIGO 2020), the French Society of Emergency Medicine (SFMU/SRLF 2019), the Diabetes Canada (DC 2018), the British Thoracic Society (BTS 2017), and the Guidelines and Audit Implementation Network (GAIN 2014).
1
2
3
4
5
6
7
8
9

Guidelines

1.Diagnostic investigations

Urine ketones: do not rule out DKA on the basis of negative urine ketones.
D
Create free account

More topics in this section

  • Capillary beta-hydroxybutyrate

  • Blood gas analysis

  • Evaluation of patients on SGLT-2 inhibitors

2.Medical management

IV fluid resuscitation: administer 0.9% sodium chloride (500 mL/hour IV for 4 hours, then 250 mL/hour for 4 hours) in order to correct hypovolemia in adult patients with DKA.
B
Show 2 more

More topics in this section

  • Insulin infusion

  • Insulin infusion (FICS)

  • Dextrose infusion

  • Potassium replacement

  • Sodium bicarbonate

  • Maintenance fluids

3.Inpatient care

Inpatient monitoring: consider obtaining close monitoring in patients with DKA, ideally in an ICU setting.
E

More topics in this section

  • Glucose monitoring

4.Patient education

Counseling on sodium-glucose cotransporter-2 inhibitors use: initiate SGLT-2 inhibitors with caution in patients with T2DM at greater risk of DKA, and after discussion with the diabetes team.
B
Show 6 more

5.Preventative measures

Withholding sodium-glucose cotransporter-2 inhibitors: as per UKKA 2021 guidelines, consider withholding SGLT-2 inhibitors for the duration of the fasting period in patients choosing to intermittently fast (such as for Ramadan), particularly in the elderly, patients on diuretics, or with CKD.
C