From the Guidelines
Diabetic Ketoacidosis (DKA) is a serious and life-threatening condition that requires prompt diagnosis and treatment, with diagnostic criteria including hyperglycemia, metabolic acidosis, and ketosis, and treatment options involving fluid replacement, insulin therapy, and electrolyte management.
Diagnostic Criteria
The diagnostic criteria for DKA include:
- Hyperglycemia (plasma glucose > 250 mg/dL [13.9 mmol/L]) or a history of diabetes
- Metabolic acidosis (venous pH < 7.3 or arterial pH < 7.25)
- Ketosis (moderate to large ketonuria or ketonemia) 1
Treatment Options
Treatment options for DKA include:
- Fluid replacement: to restore circulatory volume and tissue perfusion, with a goal of administering 1.5 to 2 times the maintenance fluid requirements in the first 24 hours 1
- Insulin therapy: to resolve hyperglycemia and ketosis, with a recommended initial dose of 0.1 units/kg/hour of regular insulin, and adjustments made based on glucose and ketone levels 1
- Electrolyte management: to correct electrolyte imbalances, particularly potassium and phosphate, with careful monitoring and replacement as needed 1
- Identification and treatment of underlying causes: such as infection, myocardial infarction, or stroke, to prevent recurrence of DKA 1
Management
Management of DKA involves:
- Close monitoring: of glucose, ketone, and electrolyte levels, as well as vital signs and mental status 1
- Adjustments to insulin and fluid therapy: based on laboratory results and clinical status 1
- Prevention of complications: such as cerebral edema, hypoxemia, and noncardiogenic pulmonary edema, through careful management of fluids and electrolytes 1 It is essential to note that the treatment of DKA should be individualized based on the patient's specific needs and clinical status, and that prompt recognition and treatment are critical to preventing morbidity and mortality 1.
From the Research
Diagnostic Criteria for Diabetic Ketoacidosis (DKA)
- DKA is characterized by hyperglycemia, metabolic acidosis, and ketosis 2, 3, 4, 5, 6
- Serum glucose level greater than 250 mg per dL, a pH less than 7.3, a serum bicarbonate level less than 18 mEq per L, an elevated serum ketone level, and dehydration are key diagnostic criteria 5
- Common symptoms include polyuria with polydipsia, weight loss, fatigue, dyspnea, vomiting, preceding febrile illness, abdominal pain, and polyphagia 5
Treatment Options for DKA
- Management of DKA involves careful clinical evaluation, correction of metabolic abnormalities, identification and treatment of precipitating and comorbid conditions, appropriate long-term treatment of diabetes, and plans to prevent recurrence 2, 3, 4, 6
- Administering intravenous fluids and insulin, and monitoring glucose and electrolyte levels are essential components of treatment 5
- Identification and treatment of the underlying precipitating event, such as infection, is crucial 4
- Discharge plans should include appropriate choice and dosing of insulin regimens and interventions to prevent recurrence of DKA 4
Prevention of DKA
- Patient education programs focusing on adherence to insulin and self-care guidelines during illness can help prevent DKA 3, 4
- Improved access to medical providers and new approaches such as extended availability of phone services, use of telemedicine, and utilization of public campaigns can provide further support for the prevention of DKA 4
- Early detection and recognition of signs of DKA can help prevent severe complications and improve outcomes 5