Diabetic Ketoacidosis
To view the entire topic, please log in or purchase a subscription.
Medicine Central™ is a quick-consult mobile and web resource that includes diagnosis, treatment, medications, and follow-up information on over 700 diseases and disorders, providing fast answers—anytime, anywhere. Explore these free sample topics:
-- The first section of this topic is shown below --
Basics
Description
- A life-threatening medical emergency in diabetics, 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 DKA) during pregnancy and in individuals taking sodium-glucose cotransporter-2 inhibitors (1).
- System(s) affected: endocrine/metabolic, neurology
Epidemiology
Incidence
Incidence by age group: 1 to 17 (10.1%), 18 to 44 (53.3%), 45 to 64 (27.1 %), 65 to 84 (8.7%), and 85+ (0.8%) (2)
Etiology and Pathophysiology
- Impaired glucose utilization secondary to insulin deficiency leading to the activation of counterregulatory 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, 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 deficiency)
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).
-- To view the remaining sections of this topic, please log in or purchase a subscription --
Basics
Description
- A life-threatening medical emergency in diabetics, 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 DKA) during pregnancy and in individuals taking sodium-glucose cotransporter-2 inhibitors (1).
- System(s) affected: endocrine/metabolic, neurology
Epidemiology
Incidence
Incidence by age group: 1 to 17 (10.1%), 18 to 44 (53.3%), 45 to 64 (27.1 %), 65 to 84 (8.7%), and 85+ (0.8%) (2)
Etiology and Pathophysiology
- Impaired glucose utilization secondary to insulin deficiency leading to the activation of counterregulatory 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, 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 deficiency)
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.