Diabetic Ketoacidosis

Overview

Diabetic ketoacidosis is a major medical emergency and remains a serious cause of morbidity, principally in people with type 1 diabetes. Normally the body metabolizes carbohydrates, leading to efficient energy production. Ketoacidosis is an alternative metabolic pathway used in starvation states. It is less efficient and produces acetone as a byproduct. A significant number of newly diagnosed diabetic patients present as ketoacidosis. In established diabetes, when patients develop an intercurrent infection, lose their appetite, and either stop or reduce their dose of insulin in the mistaken belief that under these circumstances less insulin is required. Any forms of stress, particularly that produced by infection, may precipitate severe ketoacidosis, even in patients with type 2 diabetes.

Signs and Symptoms

Gradual drowsiness, Nausea and vomiting, Abdominal pain, Polyuria, Thirsty, Weakness, Legs cramping, Dehydration, Kussmaul breathing, Hypothermia, Mental apathy, confusion, reduced consciousness

Common Causes

Infection, Insulin pump failure, Non-adherence to insulin treatment, Unrecognized symptoms of new onset of diabetes mellitus, Drug-induced, Acromegaly, Cushing's syndrome, Arterial thrombosis, Myocardial infarction, Cerebrovascular accident, Trauma, Shock/hypovolemia, Psychological stress

Investigation Techniques

Bedside and lab glucose and ketones, Full blood count, Venous blood gas for pH and bicarbonate, Blood urea and electrolytes, C-reactive protein, Urinalysis for ketones, Urine culture, Chest X-ray, Electrocardiography

Treatment and Prevention

Fluid replacement therapy, Administration of insulin, Potassium replacement(only if needed), Treating the underlying cause, Eating balanced food, Compliance to the oral diabetic and insulin treatment, Monitor glucose level