- 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
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
- Type 1 DM
- Ketosis-prone type 2 DM (Hispanic and African American ethnicity, G6PD deficiency)
- 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).
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Domino, Frank J., et al., editors. "Diabetic Ketoacidosis." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2020. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816551/all/Diabetic_Ketoacidosis.
Diabetic Ketoacidosis. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2020. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816551/all/Diabetic_Ketoacidosis. Accessed June 8, 2023.
Diabetic Ketoacidosis. (2020). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (27th ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816551/all/Diabetic_Ketoacidosis
Diabetic Ketoacidosis [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2020. [cited 2023 June 08]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816551/all/Diabetic_Ketoacidosis.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Diabetic Ketoacidosis ID - 816551 ED - Domino,Frank J, ED - Baldor,Robert A, ED - Golding,Jeremy, ED - Stephens,Mark B, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816551/all/Diabetic_Ketoacidosis PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -