Diabetic ketoacidosis
In medicine, diabetic ketoacidosis (DKA) is a type of metabolic acidosis that is a "life-threatening complication of diabetes mellitus, primarily of Type 1 Diabetes Mellitus with severe insulin deficiency and hyperglycemia. It is characterized by excessive lipolysis, oxidation of fatty acids, production of ketone bodies, a sweet smell to the breath (ketosis;) dehydration; and depressed consciousness leading to coma.[1] can also occur with Diabetes mellitus type 2[2]
DKA is often secondary to infection or other comorbidity, which must be diagnosed and treated.[3][4]
Diagnosis
The blood glucose is above 250 mg/dl in over 90% of patients.[5][6]
Urine test sticks measure acetoacetate and not 3-hydroxybutyrate (β-hydroxybutyrate) although 3-hydroxybutyrate is the predominant ketone. Acetoacetate may not be elevated until later.
The anion gap and serum osmolality must be measured.
Treatment
Treatment begins with fluid replacement; insulin is not started immediately. As DKA is treated, DKA converts from a high anion gap metabolic acidosis to a normal anion gap metabolic acidosis due to "excretion of ketone anions in the urine"[7], especially if excreted with sodium or potassium cations.
DKA is resolved when:[3]
- glucose level less than 11.1 mmol/L (200 mg/dL)
- serum bicarbonate level ≥ 18 mmol/L
- venous pH greater than 7.3
References
- ↑ Anonymous (2024), Diabetic ketoacidosis (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ Umpierrez GE, Smiley D, Kitabchi AE (2006). "Narrative review: ketosis-prone type 2 diabetes mellitus.". Ann Intern Med 144 (5): 350-7. PMID 16520476.
- ↑ 3.0 3.1 Wilson JF (2010). "In clinic. Diabetic ketoacidosis.". Ann Intern Med 152 (1): ITC1. DOI:10.1059/0003-4819-152-1-201001050-01001. PMID 20048266. Research Blogging.
- ↑ Rucker DW (February 12, 2008), "Diabetic ketoacidosis", eMedicine
- ↑ Lebovitz HE (1995). "Diabetic ketoacidosis.". Lancet 345 (8952): 767-72. PMID 7891491.
- ↑ Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN (2009). "Hyperglycemic crises in adult patients with diabetes.". Diabetes Care 32 (7): 1335-43. DOI:10.2337/dc09-9032. PMID 19564476. PMC PMC2699725. Research Blogging.
- ↑ Oh MS, Carroll HJ, Goldstein DA, Fein IA (December 1978). "Hyperchloremic acidosis during the recovery phase of diabetic ketosis". Ann. Intern. Med. 89 (6): 925–7. PMID 102229. [e]