Diabetic ketoacidosis (DKA) is an acute, major, life-threatening complication of diabetes that mainly occurs in patients with type 1 diabetes, but it is not uncommon in some patients with type 2 diabetes. This condition is a complex disordered metabolic state characterized by hyperglycemia, ketoacidosis, and ketonuria.
Signs and Symptoms:
The most common early symptoms of DKA are the insidious increase in polydipsia and polyuria. The following are other signs and symptoms of DKA:
1. Malaise, generalized weakness, and fatigability.
2. Nausea and vomiting; may be associated with diffuse abdominal pain, decreased appetite, and anorexia.
3. Rapid weight loss in patients newly diagnosed with type 1 diabetes.
4. History of failure to comply with insulin therapy or missed insulin injections due to vomiting or psychological reasons.
5. Decreased perspiration.
6. Altered consciousness (eg, mild disorientation, confusion); frank coma is uncommon but may occur when the condition is neglected or with severe dehydration/acidosis.
Diagnosis:
On examination, general findings of DKA may include the following:
Ill appearance
Dry skin
Labored respiration
Dry mucous membranes
Decreased skin turgor
Decreased reflexes
Characteristic acetone (ketotic) breath odor
Tachycardia
Hypotension
Tachypnea
Hypothermia
Laboratory Tests:
Serum glucose levels
Serum electrolyte levels (eg, potassium, sodium, chloride, magnesium, calcium, phosphorus)
Amylase levels
Urine dipstick
Ketone levels
Serum or capillary beta-hydroxybutyrate levels
ABG measurements
Bicarbonate levels
CBC count
BUN and creatinine levels
Management:
Treatment of ketoacidosis should aim for the following:
Fluid resuscitation
Reversal of the acidosis and ketosis
Reduction in the plasma glucose concentration to normal
Replenishment of electrolyte and volume losses
Identification the underlying cause
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