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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
- 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
-- To view the remaining sections of this topic, please log in or purchase a subscription --
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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