Diabetic Ketoacidosis

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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, which most commonly occurs in patients with type 1 diabetes
  • Rarely, it can occur in the absence of hyperglycemia in individuals taking sodium-glucose cotransporter-2 (SGLT2) inhibitors (1).
  • System(s) affected: endocrine/metabolic

Epidemiology

Incidence
  • Per the United States Diabetes Surveillance System: In 2016, age adjusted hospitalization rates for persons >18 years of age was approximately 21/1,000 for diabetic ketoacidosis (DKA) with an overall increase from 2,000 (2).
  • Predominant age: 18 to 44 years (79%) and 45 to 64 years (12%), 65 to 74 years (4%) and 75+ years (3%)

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

  • Nonadherence to diabetic medications may account for upward of 44% of cases. Other causes include the following:
    • Infection
    • First presentation of DM
    • Myocardial infarction (MI)
    • No cause identified
    • Medications (corticosteroids, sympathomimetics, atypical antipsychotics, SGLT2 inhibitors*)
    • Illicit drugs (cocaine)
    • Trauma
    • Surgery
    • Emotional stress
    • Pregnancy
    • Cerebrovascular accident (CVA)
*Has been shown to be associated with a euglycemic DKA (3)

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
  • Education on symptom recognition

Commonly Associated Conditions

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

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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, which most commonly occurs in patients with type 1 diabetes
  • Rarely, it can occur in the absence of hyperglycemia in individuals taking sodium-glucose cotransporter-2 (SGLT2) inhibitors (1).
  • System(s) affected: endocrine/metabolic

Epidemiology

Incidence
  • Per the United States Diabetes Surveillance System: In 2016, age adjusted hospitalization rates for persons >18 years of age was approximately 21/1,000 for diabetic ketoacidosis (DKA) with an overall increase from 2,000 (2).
  • Predominant age: 18 to 44 years (79%) and 45 to 64 years (12%), 65 to 74 years (4%) and 75+ years (3%)

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

  • Nonadherence to diabetic medications may account for upward of 44% of cases. Other causes include the following:
    • Infection
    • First presentation of DM
    • Myocardial infarction (MI)
    • No cause identified
    • Medications (corticosteroids, sympathomimetics, atypical antipsychotics, SGLT2 inhibitors*)
    • Illicit drugs (cocaine)
    • Trauma
    • Surgery
    • Emotional stress
    • Pregnancy
    • Cerebrovascular accident (CVA)
*Has been shown to be associated with a euglycemic DKA (3)

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
  • Education on symptom recognition

Commonly Associated Conditions

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

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