Common Precipitants of Diabetic Ketoacidosis (DKA)
Infection is the most common precipitating factor for diabetic ketoacidosis, occurring in 30-50% of cases, followed by inadequate insulin therapy. 1, 2
Major Precipitating Factors
Infections
- Urinary tract infections and pneumonia account for the majority of infectious causes 2
- Other infections include respiratory tract infections, septicemia, and throat infections 1, 3
- Bacterial cultures of urine, blood, and throat should be obtained when infection is suspected 1
Insulin-Related Factors
- New-onset type 1 diabetes (undiagnosed diabetes) 1
- Discontinuation of insulin therapy in established type 1 diabetes 1
- Inadequate insulin dosing or non-compliance with insulin therapy 2, 3
- Economic factors may lead to insulin discontinuation, particularly in underserved populations 1
Medications
- Drugs that affect carbohydrate metabolism can precipitate DKA, including:
Acute Medical Conditions
- Cerebrovascular accidents 1
- Alcohol abuse 1
- Pancreatitis 1
- Myocardial infarction 1, 2
- Trauma 1, 2
- Surgery 2
Other Factors
- Psychological stress 2
- Inability to maintain adequate hydration, particularly in elderly patients 1
- Limited access to medical care 2
Clinical Presentation and Diagnosis
DKA typically presents with:
- Polyuria, polydipsia, polyphagia, weight loss 1
- Nausea and vomiting (present in up to 57.7% of cases) 3
- Abdominal pain (42.2% of cases) 3
- Dehydration (42.2% of cases) 3
- Kussmaul respirations (deep, labored breathing) 1
- Altered mental status ranging from alertness to coma 1
Prevention Strategies
Effective prevention of DKA requires:
- Patient education on sick-day management 1
- Regular blood glucose monitoring, especially during illness 6
- Never discontinuing insulin, even during illness 1
- Early contact with healthcare providers when illness occurs 1
- Improved access to medical care and diabetes education 2
- Recognition of early warning signs of hyperglycemia 6
Special Considerations
- Elderly patients with new-onset diabetes or known diabetes who become hyperglycemic and are unable to maintain adequate hydration are at particular risk for hyperosmolar hyperglycemic state (HHS) 1
- In developing countries, mortality from DKA remains high despite overall declining rates 4
- Patients using SGLT2 inhibitors require special monitoring due to increased risk of DKA 4, 5
Understanding these precipitating factors is crucial for both prevention and prompt management of DKA, which can significantly reduce morbidity and mortality associated with this acute complication of diabetes.