From the Guidelines
Diabetic Ketoacidosis (DKA) is a serious complication of diabetes that requires immediate medical attention, and its treatment typically involves intravenous fluids, insulin therapy, and electrolyte replacement, with the goal of restoring circulatory volume, resolving ketoacidosis, and correcting electrolyte imbalance and acidosis, as recommended by the most recent guidelines 1.
Symptoms of DKA
The symptoms of DKA include:
- Excessive thirst
- Frequent urination
- Nausea
- Vomiting
- Abdominal pain
- Weakness
- Fatigue
- Confusion
- Fruity-scented breath
- Rapid breathing In severe cases, it can lead to altered mental status and coma.
Treatment of DKA
The treatment of DKA requires:
- Intravenous fluids to rehydrate the body, usually normal saline at 15-20 mL/kg in the first hour
- Insulin therapy, typically an IV insulin infusion at 0.1 units/kg/hour after an initial bolus of 0.1 units/kg
- Electrolyte replacement, particularly potassium, as levels often drop with treatment
- Blood glucose, electrolytes, and pH levels must be monitored frequently during treatment
- The underlying cause, often infection, medication non-compliance, or newly diagnosed diabetes, must be identified and addressed
- Successful transition from intravenous to subcutaneous insulin requires administration of basal insulin 2–4 h prior to the intravenous insulin being stopped to prevent recurrence of ketoacidosis and rebound hyperglycemia, as recommended by recent guidelines 1.
Management Goals
The management goals of DKA include:
- Restoration of circulatory volume and tissue perfusion
- Resolution of ketoacidosis
- Correction of electrolyte imbalance and acidosis
- Treatment of any correctable underlying cause of DKA, such as sepsis, myocardial infarction, or stroke
- Education on diabetes management, including insulin administration, blood glucose monitoring, and sick day protocols to prevent recurrence, as emphasized by recent studies 1.
From the FDA Drug Label
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. Heavy breathing and a rapid pulse are more severe symptoms
- Symptoms of DKA include:
- Drowsy feeling
- Flushed face
- Thirst
- Loss of appetite
- Fruity odor on the breath
- Heavy breathing
- Rapid pulse
- Treatment of DKA is not explicitly described in the provided text, but it is mentioned that medical assistance should be obtained immediately if symptoms of DKA occur 2 2
- It is also mentioned that hyperglycemia or DKA can lead to nausea, vomiting, stomach pain, dehydration, loss of consciousness, or death if left uncorrected 2 2
From the Research
Symptoms of Diabetic Ketoacidosis (DKA)
- Polyuria and polydipsia are the most common symptoms, followed by nausea, vomiting, abdominal pain, weight loss, severe fatigue, dyspnea, and preceding febrile illness 3
- Fatigue, polydipsia, polyuria, weakness, weight loss, nausea, vomiting, and abdominal pain with tachycardia and tachypnea on exam 4
- Dehydration, loss of electrolytes, hyperglycemia, hyperketonemia, acidosis and progressive loss of consciousness 5
Treatment of Diabetic Ketoacidosis (DKA)
- Restoration of circulating volume, insulin therapy, electrolyte replacement and treatment of any underlying precipitating event 6
- Fluid and electrolyte replacement, insulin, treatment of precipitating causes, and close monitoring to adjust therapy and identify complications 3
- Restoration of circulating volume and electrolyte replacement; correction of insulin deficiency aiming at the resolution of metabolic acidosis and ketosis; reduction of risk of cerebral edema; avoidance of other complications of therapy 5
- Alternative management protocols may include stopping intravenous fluid when oral fluids are well tolerated, oral potassium replacement, and subcutaneous rapid-acting insulin analog administration 5
Diagnosis of Diabetic Ketoacidosis (DKA)
- A diagnosis of DKA is confirmed when all of the three criteria are present - 'D', either elevated blood glucose levels or a family history of diabetes mellitus; 'K', the presence of high urinary or blood ketoacids; and 'A', a high anion gap metabolic acidosis 6
- Hyperglycemia, metabolic acidosis, and elevated serum or urine ketones 3
- Biochemical criteria for diagnosis include: blood glucose > 200 mg/dl, venous pH <7.3 or bicarbonate <15 mEq/L, ketonemia >3 mmol/L and presence of ketonuria 5