Diabetic ketoacidosis

• What happens in DKA?

  Absolute or relative insulin deficiency resulting in hyperglycaemia, high ketone levels due to cortisol, glucagon and adrenaline secretion leading to gluconeogenesis and glycogenolysis, and acidosis.
• What can precipitate DKA?

  • Insulin omission
  • Infection
  • Acute intercurrent illness or injury
• Can someone be in DKA without hyperglycaemia?

  Yes. Those with known diabetes who are taking SGLT2 inhibitors may have euglycaemic DKA. They should be managed as per DKA.
• What are the symptoms of DKA?

  Thirst

  Polyuria to reduced urine output

  Abdominal pain

  Nausea and vomiting

  Fatigue

  Confusion

  Palpitations
• What are the clinical signs of DKA?

  Dehydration can cause:

  • Tachycardia
  • Hypotension
  • Reduced skin turgor
  • Dry mucous membranes

  Kussmaul breathing - rapid deep breathing

  Pear drop/acetone smell to breath

  Cerebral oedema - may present with decreased consciousness
• What is the criteria for DKA diagnosis?

  1. Hyperglycaemia blood glucose >11.0mmol/L or known diabetes
  2. Capillary Ketones >3.0mmol/L or urine ketones 2+ or more
  3. Venous pH <7.3 and/or bicarbonate of <15.0mmol/L
• What are the 3 principles of management in DKA?

  1. Fluid rescuscitation and maintenance
  2. Insulin therapy
  3. Electrolyte replacement - IV potassium
• What are the complications of DKA?

  AKI

  Iatrogenic hypoglycaemia

  Hyperkalaemia

  Cerebral oedema

  Pancreatitis

  Rhabdomyolysis

  GI bleeding