Diabetic Ketoacidosis

Diabetic Ketoacidosis is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • A life-threatening medical emergency in diabetics secondary to insulin deficiency and characterized by hyperglycemia, ketosis, metabolic acidosis, electrolyte disturbances, and marked dehydration
  • System(s) affected: endocrine/metabolic

Epidemiology

Incidence
  • In the United States: 46 episodes per 10,000 diabetics; 2/100 patient-years of type 1 diabetes mellitus (DM) (1)
  • Predominant age: 19 to 44 years (56%) and 45 to 65 years (24%); only 18% are <20 years.

Etiology and Pathophysiology

A deficiency of insulin, exacerbated by an increase in counterregulatory hormones (e.g., catecholamines, cortisol, glucagon, and growth hormone) leading to a hyperglycemic crisis, osmotic diuresis, ketosis with metabolic acidosis, and frequently accompanied by electrolyte disturbances

  • Noncompliance/insufficient insulin: 25%
  • Infection: 30–40%
  • First presentation of DM: 10–25%
  • Myocardial infarction (MI): 5–7%
  • No cause identified: 10–30%
  • Medications (corticosteroids, sympathomimetics, atypical antipsychotics)
  • Illicit drugs (cocaine)
  • Trauma
  • Surgery
  • Emotional stress
  • Pregnancy
  • Cerebrovascular accident (CVA)

Risk Factors

  • Type 1 > type 2 DM
  • Younger patients at higher risk

General Prevention

  • Close monitoring of glucose during periods of stress, infection, illness, and trauma
  • Careful insulin control and regular monitoring of blood glucose levels
  • “Sick day” management instructions

Commonly Associated Conditions

Complications of chronic (and poorly controlled) DM such as nephropathy, neuropathy, and retinopathy

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