Diabetic ketoacidosis

• Diabetic ketoacidosis (DKA) is a serious, potentially life-threatening complication of diabetes mellitus.
• Characterised by hyperglycaemia, ketosis, and metabolic acidosis.
• Occurs primarily in type 1 diabetes mellitus, but can also occur in type 2.
• Requires urgent medical treatment.

• Incidence: higher in type 1 diabetes mellitus.
• DKA is a common initial presentation in newly diagnosed type 1 diabetes.
• Can occur at any age but more common in younger patients.
• Increased risk in patients with poor glycaemic control or those who miss insulin doses.
• Mortality rate has decreased with improved treatment protocols.

1. Insulin deficiency leads to increased lipolysis, releasing free fatty acids.
2. Ketogenesis in the liver produces ketone bodies (beta-hydroxybutyrate, acetoacetate).
3. Accumulation of ketone bodies leads to metabolic acidosis.

• Absolute or relative insulin deficiency.
• Increased counter-regulatory hormones (glucagon, cortisol, catecholamines).
• Triggers:
  • Infection.
  • Stress.
  • Inadequate insulin therapy.
  • Myocardial infarction.
  • Trauma.

• Polyuria (frequent urination).
• Polydipsia (excessive thirst).
• Nausea and vomiting.
• Abdominal pain.
• Fatigue and weakness.
• Altered mental status (confusion, drowsiness).
• Symptoms of underlying infection (if present).
• Weight loss.
• Dehydration symptoms (dry mouth, skin).

• Tachycardia.
• Hypotension.
• Kussmaul respirations (deep, laboured breathing).
• Fruity breath odour (acetone).
• Dehydration signs (dry mucous membranes, reduced skin turgor).
• Altered consciousness (lethargy, coma).
• Abdominal tenderness.
• Signs of infection (fever, cough, etc.).
• Hyperglycaemia (blood glucose > 11 mmol/L).
• Ketosis (positive urine or serum ketones).
• Metabolic acidosis (low bicarbonate, pH < 7.3).

• Blood glucose levels (typically > 11 mmol/L).
• Serum ketones (beta-hydroxybutyrate).
• Arterial blood gases (metabolic acidosis).
• Electrolytes (hyperkalaemia, hyponatremia).
• Urinalysis (glucosuria, ketonuria).
• Renal function tests (creatinine, urea).
• Complete blood count (leucocytosis).
• Infection screen (blood cultures, chest X-ray).
• ECG: to detect hyperkalaemia effects.
• Plasma osmolality.

• Glucose >11mmol/L (NB. glucose may be normal in some circumstances – ‘euglycaemic DKA’, e.g. if taken insulin recently, on SGLT-2 inhibitor, during pregnancy).
• pH <7.3 or HCO₃^–  <15mmol/L.
• Capillary ketones >3mmol/L (or ++ urinary ketones).

• Fluid replacement (IV 0.9% saline).
• Insulin therapy (fixed rate IV insulin infusion).
• Electrolyte management (potassium replacement).
• Monitoring of blood glucose and electrolytes.
• Address underlying cause (e.g., antibiotics for infection).

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• Cerebral oedema.
• Hypokalaemia.
• Hypoglycaemia (from overcorrection).
• Acute respiratory distress syndrome (ARDS).
• Acute kidney injury.
• Thromboembolism.
• Infections.
• Death (if untreated or severe).

• Good with prompt and appropriate treatment.
• Mortality rate < 1% with proper management.
• Higher risk in elderly and those with comorbid conditions.
• Long-term prognosis depends on overall diabetes management.
• Regular follow-up and patient education reduce recurrence.

• DKA is a medical emergency requiring prompt treatment.
• Characterised by hyperglycaemia, ketosis, and metabolic acidosis.
• Management includes fluids, insulin, and electrolyte replacement.
• Early recognition and treatment are crucial to prevent complications.
• Follow local guidelines for management (e.g., NICE guidelines).
• Patient education is essential to prevent recurrence.