Diabetic ketoacidosis

Diabetic ketoacidosis 

Updated: 01/21/2021

© Jun Wang, MD, PhD

General features
  • Life threatening
  • More common in type 1 diabetes
  • Usually associated with concomitant infection, missed or disrupted insulin treatments, or medical/emotional stress
  • Diagnosed based on history, clinical presentation, and elevated ketone levels
Key pathogenesis
  • Exaggerated insulin deficiency due to elevated anti insulin effects caused by increased epinephrine, etc
  • Accelerated fat metabolism (lipolysis, increase free fatty acid, etc) and ketogenesis
  • Accumulation of ketones due to impaired urinary excretion following dehydration
Clinical presentations
  • Most common: Insidious increase in polydipsia and polyuria
  • Non specific symptoms: Malaise, generalized weakness, and fatigability, nausea and vomiting
  • Signs: Shallow rapid breathing early (sighing respiration) or air hunger (Kussmaul) if acidosis grows severe, abdominal tenderness, and disturbance of consciousness
  • Hyperosmorality
  • Osmotic diuresis
  • Coma
Key Laboratory findings
  • Hyperglycemia
  • Metabolic acidosis
  • Ketosis
  • Ketonuria
  • Impaired renal function
Managements
  • Insulin
  • Electrolyte supplements and alkalinizing agents for acidosis, etc


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