From the Guidelines
Diabetic ketoacidosis (DKA) is a serious complication of diabetes characterized by hyperglycemia, ketone production, and metabolic acidosis, requiring individualized treatment based on careful clinical and laboratory assessment. The presentation of DKA can vary greatly, ranging from mild hyperglycemia and acidosis to severe hyperglycemia, dehydration, and coma 1. Management goals include restoring circulatory volume and tissue perfusion, resolving hyperglycemia, and correcting electrolyte imbalance and acidosis. It is also essential to treat any underlying cause of DKA, such as sepsis, myocardial infarction, or stroke.
Key Characteristics of DKA
- Hyperglycemia (typically >250 mg/dL)
- Ketones in blood or urine
- Metabolic acidosis with a pH <7.3 and low bicarbonate levels
Treatment Approach
- Intravenous fluids to rehydrate
- Insulin therapy to reduce blood glucose and stop ketone production
- Electrolyte replacement (particularly potassium)
- Treatment of any underlying cause of DKA 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 1. Additionally, the use of bicarbonate in patients with DKA is generally not recommended, as it has been shown to make no difference in the resolution of acidosis or time to discharge 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. Heavy breathing and a rapid pulse are more severe symptoms If uncorrected, prolonged hyperglycemia or DKA can lead to nausea, vomiting, stomach pain, dehydration, loss of consciousness, or death.
Diabetic Ketoacidosis (DKA) is a life-threatening emergency that can occur in patients with type 1 or insulin-dependent diabetes due to prolonged hyperglycemia. The symptoms of DKA include:
- Drowsy feeling
- Flushed face
- Thirst
- Loss of appetite
- Fruity odor on the breath
- Heavy breathing
- Rapid pulse DKA can lead to severe complications, such as nausea, vomiting, stomach pain, dehydration, loss of consciousness, or death if left uncorrected 2.
From the Research
Definition of Diabetic Ketoacidosis (DKA)
- Diabetic ketoacidosis (DKA) is a life-threatening condition characterized by hyperglycemia, metabolic acidosis, and ketonemia 3, 4, 5.
- DKA is typically diagnosed by the presence of hyperglycemia, acidemia, and ketonemia, although some cases may present with euglycemic or hypoglycemic DKA 6.
- The triad of uncontrolled hyperglycemia, metabolic acidosis, and increased total body ketone concentration characterizes DKA 7.
Key Characteristics of DKA
- Hyperglycemia: elevated blood glucose levels 3, 4, 5.
- Metabolic acidosis: high anion gap metabolic acidosis 4, 5.
- Ketonemia: presence of high urinary or blood ketoacids 4, 5.
- Dehydration: reduction in effective circulating volume 3, 5.