Diabetic ketoacidosis

"DKA" redirects here. For other uses, see DKA (disambiguation).

Diabetic ketoacidosis
Dehydration may be severe in diabetic ketoacidosis, and intravenous fluids are usually needed as part of its treatment.
SpecialtyEndocrinology
SymptomsVomiting, abdominal pain, deep gasping breathing, increased urination, confusion, a specific smell[1]
ComplicationsCerebral edema[2]
Usual onsetRelatively rapid[1]
CausesShortage of insulin[3]
Risk factorsUsually type 1 diabetes, less often other types[1]
Diagnostic methodHigh blood sugar, low blood pH, high ketoacid levels[1]
Differential diagnosisHyperosmolar nonketotic state, alcoholic ketoacidosis, uremia, salicylate toxicity[4]
TreatmentIntravenous fluids, insulin, potassium[1]
Frequency4–25% of people with type 1 diabetes per year[1][5]

Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes mellitus.[1] Signs and symptoms may include vomiting, abdominal pain, deep gasping breathing, increased urination, weakness, confusion and occasionally loss of consciousness.[1] A person's breath may develop a specific "fruity" smell.[1] The onset of symptoms is usually rapid.[1] People without a previous diagnosis of diabetes may develop DKA as the first obvious symptom.[1]

DKA happens most often in those with type 1 diabetes but can also occur in those with other types of diabetes under certain circumstances.[1] Triggers may include infection, not taking insulin correctly, stroke and certain medications such as steroids.[1] DKA results from a shortage of insulin; in response, the body switches to burning fatty acids, which produces acidic ketone bodies.[3] DKA is typically diagnosed when testing finds high blood sugar, low blood pH and keto acids in either the blood or urine.[1]

The primary treatment of DKA is with intravenous fluids and insulin.[1] Depending on the severity, insulin may be given intravenously or by injection under the skin.[3] Usually, potassium is also needed to prevent the development of low blood potassium.[1] Throughout treatment, blood sugar and potassium levels should be regularly checked.[1] Underlying causes for the DKA should be identified.[6] In those with severely low blood pH who are critically ill, sodium bicarbonate may be given; however, its use is of unclear benefit and typically not recommended.[1][6]

Rates of DKA vary around the world.[5] Each year, about 4% of type 1 diabetics in the United Kingdom develop DKA, versus 25% of type 1 diabetics in Malaysia.[1][5] DKA was first described in 1886, and until the introduction of insulin therapy in the 1920s, it was almost universally fatal.[7] With adequate and timely treatment, the risk of death is between <1% and 5%.[1][6]

  1. ^ a b c d e f g h i j k l m n o p q r s t Misra S, Oliver NS (October 2015). "Diabetic ketoacidosis in adults". BMJ. 351: h5660. doi:10.1136/bmj.h5660. hdl:10044/1/41091. PMID 26510442. S2CID 38872958.
  2. ^ Cite error: The named reference Bia2015 was invoked but never defined (see the help page).
  3. ^ a b c Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN (July 2009). "Hyperglycemic crises in adult patients with diabetes". Diabetes Care. 32 (7): 1335–1343. doi:10.2337/dc09-9032. PMC 2699725. PMID 19564476.
  4. ^ Ferri FF (2010). Ferri's Differential Diagnosis: A Practical Guide to the Differential Diagnosis of Symptoms, Signs, and Clinical Disorders. Elsevier Health Sciences. p. 146. ISBN 978-0323076999. Archived from the original on 2017-09-08.
  5. ^ a b c Maletkovic J, Drexler A (December 2013). "Diabetic ketoacidosis and hyperglycemic hyperosmolar state". Endocrinology and Metabolism Clinics of North America. 42 (4): 677–695. doi:10.1016/j.ecl.2013.07.001. PMID 24286946.
  6. ^ a b c Cite error: The named reference JBDS was invoked but never defined (see the help page).
  7. ^ Eledrisi MS, Alshanti MS, Shah MF, Brolosy B, Jaha N (May 2006). "Overview of the diagnosis and management of diabetic ketoacidosis". The American Journal of the Medical Sciences. 331 (5): 243–251. doi:10.1097/00000441-200605000-00002. PMID 16702793.