Diabetic Ketoacidosis

BASICS

DESCRIPTION

  • A life-threatening medical emergency which most commonly occurs in patients with type 1 diabetes
  • Characterized by a biochemical triad of hyperglycemia, ketosis, and high anion gap metabolic acidosis
  • Rarely, it can occur in the absence of hyperglycemia (i.e., euglycemic diabetic ketoacidosis [DKA]) during pregnancy and in individuals taking sodium-glucose cotransporter-2 (SGLT2) inhibitors (1).
  • System(s) affected: endocrine/metabolic, neurologic

EPIDEMIOLOGY

Incidence

Incidence by age group: 1 to 17 years (10.1%), 18 to 44 years (53.3%), 45 to 64 years (27.1%), 65 to 84 years (8.7%), and ≥85 years (0.8%)

ETIOLOGY AND PATHOPHYSIOLOGY

  • Impaired glucose utilization secondary to insulin deficiency, leading to the activation of counter regulatory mechanisms (gluconeogenesis, glycogenolysis, proteolysis) which further increase blood glucose level and trigger ketone bodies production; resulting ketonemia and hyperglycemia lead to osmotic diuresis, dehydration, electrolytes disturbances, and acidosis.
  • Leading causes include medication noncompliance and infection. Other precipitating factors are:
    • First presentation of DM
    • Myocardial infarction (MI); cerebrovascular accident (CVA)
    • Medications (corticosteroids, sympathomimetics [e.g., dobutamine and terbutaline], atypical antipsychotics, SGLT2 inhibitors)
    • Alcohol and illicit drugs (cocaine)
    • Trauma; surgery
    • Emotional stress and psychiatric comorbidities
    • Pregnancy

RISK FACTORS

  • Type 1 DM
  • Ketosis-prone type 2 DM (Hispanic and African American ethnicity, G6PD)
  • Euglycemic ketoacidosis specially with SGLT2 inhibitor drug use
  • COVID-19 infection
  • Younger age at the time of DKA hospitalization, higher A1C level, lower physical activity, lower socioeconomic status, and psychiatric symptoms have been associated with increased rates of DKA

GENERAL PREVENTION

  • Close monitoring of glucose during periods of stress, illness, and trauma with “sick day” management instructions
  • Careful insulin control and regular monitoring of blood glucose levels along with education on symptom recognition

COMMONLY ASSOCIATED CONDITIONS

>30% of patients have features of both DKA and hyperosmolar hyperglycemic syndrome (HHS).

There's more to see -- the rest of this topic is available only to subscribers.

© 2000–2025 Unbound Medicine, Inc. All rights reserved
All content is protected by copyright and may not be used for AI model training or other unauthorized purposes.