Diabetic Ketoacidosis Flashcards
Defintion
Diabetic ketoacidosis (DKA) is a serious problem that can happen in people with diabetes if their body starts to run out of insulin. When this happens, harmful substances called ketones build up in the body, which can be life-threatening if it’s not found and treated quickly
Characterised by a biochemical triad of hyperglycaemia, ketonaemia, and acidaemia
Aetiology/Risk factors
Can be triggered by an infection or other illness
This can cause your body to produce higher levels of certain hormones, such as adrenaline or cortisol
These hormones can counter the effect of insulin and trigger DKA
Missed insulin/inadequate insulin treatments can also trigger DKA
Risk factors: Acute infection MI Stroke Pancreatitis Pregnancy Trauma Drugs (corticosteroids, thiazide diuretics, sympathomimetics, SGLT-2 inhibitors) Alcohol/drug abuse
Epidemiology
Most common among patients with type 1 diabetes mellitus
Less common in type 2 diabetes but can happen
Presenting symptoms
Polyuria Polydipsia Polyphagia Nausea and vomiting Abdominal pain Weakness or fatigue Shortness of breath Fruity-scented breath Confusion Palpitations
Signs on physical examination
Tachycardia Hypotension Reduced skin turgor Dry mucous membranes Reduced urine output Altered consciousness (eg confusion, coma) Kussmaul breathing
Hyperglycaemia - blood glucose >11.0mmol/L
Ketonaemia - ketones >3.0mmol/L or significant ketonuria
Acidosis - bicarbonate < 15.0mmol/L and/or venous pH < 7.3
Investigations
First line: Plasma glucose (>250mg/dL) ABG (may show acidosis) Capillary or serum ketones Urinalysis (glucose and ketones) U&Es LFTs Blood urea nitrogen Creatinine
Consider: Chest x-ray (may show pneumonia) ECG (may show MI or hypo/hyperkalaemia) Cardiac biomarkers (elevated in MI) Blood, urine or sputum cultures
Management plan
Acute
Specifics depends on level of volume depletion and sodium levels
First line to give intravenous fluids
Plus supportive care/ICU admission, potassium therapy, insulin therapy once potassium is at 3.3mEq/L, bicarbonate therapy, phosphate therapy
Ongoing
If DKA resolved and patient is able to tolerate oral intake then first line treatment is to establish a regular subcutaneous insulin regime
Treat comorbid precipitating event if present (MI, pneumonia etc)
Complications
Complications of treatment: Hypoglycaemia Hypokalaemia Hypoxaemia Pulmonary oedema (rare) Cerebral oedema (rare but rapidly fatal, mainly in children)
Prognosis
With prompt treatment, more than 95% of patients recover
Mortality rate of around 2-5%, higher in older patients
Shock or coma on admission indicates worse prognosis
Children who develop cerebral oedema (57% recover completely, 21% mortality rate)
