Diabetic Ketoacidosis

Diabetic Ketoacidosis is a topic covered in the Washington Manual of Medical Therapeutics.

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General Principles

Epidemiology

DKA, a potentially fatal complication of diabetes, occurs in up to 5% of patients with T1DM annually and can occur in insulin-deficient patients with T2DM.

Pathophysiology

DKA is a catabolic condition that results from severe insulin deficiency, often in association with stress and activation of counterregulatory hormones (e.g., catecholamines, glucagon).

Risk Factors

Precipitating factors for DKA include inadvertent or deliberate interruption of insulin therapy, sepsis, trauma, myocardial infarction (MI), and pregnancy. DKA may be the first presentation of T1DM and, rarely, T2DM. DKA with euglycemia or lower-than-expected glucoses can occur with use of the sodium glucose cotransport inhibitor 2 (SGLT-2) antidiabetes drugs, with atypical antipsychotic agents and with some cancer chemotherapy.

Prevention

DKA can be prevented in many cases, and its occurrence suggests a breakdown in education, communication, and problem solving. Therefore, diabetes education should be reinforced at every opportunity, with special emphasis on (1) self-management skills during sick days; (2) the body’s need for more, rather than less, insulin during such illnesses; (3) testing of blood or urine for ketones; and (4) procedures for obtaining timely and preventive medical advice.

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