From the Guidelines
Diabetic ketoacidosis (DKA) is a serious complication of diabetes characterized by hyperglycemia, ketosis, and metabolic acidosis, typically defined by blood glucose levels above 250 mg/dL, the presence of ketones in blood or urine, and a blood pH below 7.3 with a bicarbonate level less than 18 mEq/L, as stated in the most recent guidelines 1.
Definition and Diagnosis
DKA occurs when the body cannot use glucose for energy due to insufficient insulin, causing it to break down fat for fuel instead, which produces ketones that accumulate in the blood. The condition develops when insulin deficiency is combined with increased levels of counter-regulatory hormones like glucagon, cortisol, and catecholamines, which typically happens during illness, infection, or when insulin doses are missed 1.
Key Characteristics
Some key characteristics of DKA include:
- Hyperglycemia
- Ketosis
- Metabolic acidosis
- Blood glucose levels above 250 mg/dL
- Presence of ketones in blood or urine
- Blood pH below 7.3 with a bicarbonate level less than 18 mEq/L
Management and Treatment
Management goals for DKA include restoration of circulatory volume and tissue perfusion, resolution of hyperglycemia, and correction of electrolyte imbalance and acidosis, with treatment focusing on fluid replacement, insulin therapy, and electrolyte correction to address the underlying metabolic derangements 1.
Recent Guidelines
According to the most recent guidelines, there is no significant difference in outcomes for intravenous human regular insulin versus subcutaneous rapid-acting analogs when combined with aggressive fluid management for treating mild or moderate DKA, and the use of bicarbonate in patients with DKA is generally not recommended 1.
From the FDA Drug Label
Hyperglycemia (too much glucose in the blood) may develop if your body has too little insulin. Hyperglycemia can be brought about by any of the following: Omitting your insulin or taking less than your doctor has prescribed. In patients with type 1 or insulin-dependent diabetes, prolonged hyperglycemia can result in DKA (a life-threatening emergency) The first symptoms of DKA usually come on gradually, over a period of hours or days, and include a drowsy feeling, flushed face, thirst, loss of appetite, and fruity odor on the breath. With DKA, blood and urine tests show large amounts of glucose and ketones.
Diabetic Ketoacidosis (DKA) is constituted by:
- Prolonged hyperglycemia
- Presence of ketones in the blood and urine
- Symptoms such as:
From the Research
Definition of Diabetic Ketoacidosis (DKA)
Diabetic ketoacidosis (DKA) is a serious complication of diabetes that occurs when the body produces high levels of blood acids called ketones. The condition is characterized by:
- Hyperglycemia (high blood sugar levels) [ 3, 4, 5, 6 ]
- Ketosis (presence of ketones in the blood or urine) [ 3, 7, 4, 5, 6 ]
- Metabolic acidosis (high anion gap acidosis) [ 3, 7, 4, 5, 6 ]
Diagnostic Criteria
A diagnosis of DKA is confirmed when all three of the following criteria are present:
- 'D': elevated blood glucose levels or a family history of diabetes mellitus [ 3 ]
- 'K': presence of high urinary or blood ketoacids [ 3 ]
- 'A': high anion gap metabolic acidosis [ 3 ]
Special Considerations
DKA can also occur in patients with euglycemia (normal blood sugar levels) [ 7 ] and can be masked by other metabolic derangements, such as primary metabolic alkalosis [ 7 ].