Overview
Definition
A life-threatening complication of diabetes characterized by hyperglycemia, ketoacidosis, and ketonuria.
Epidemiology
Most common in Type 1 Diabetes, but can occur in Type 2 (often under extreme stress).
Etiology & Risk Factors
- Absolute or relative insulin deficiency
- Infection/Sepsis (most common trigger)
- Non-compliance with insulin
- Myocardial infarction
- Medications (e.g., SGLT2 inhibitors causing euglycemic DKA)
Clinical Symptoms
- Nausea and vomiting
- Abdominal pain
- Fruity breath odor (acetone)
- Kussmaul respirations (deep, rapid breathing)
- Altered mental status / coma
Clinical Approach
Diagnosis
- Blood glucose > 250 mg/dL (usually)
- Arterial pH < 7.30
- Serum bicarbonate < 18 mEq/L
- Presence of serum or urine ketones
- Anion gap metabolic acidosis
Management
- AGGRESSIVE IV Fluid Resuscitation (NS then 1/2 NS, add D5 when glucose < 250)
- Continuous IV Insulin Infusion
- Potassium replacement (critical, as insulin shifts K+ intracellularly)
- Identify and treat the underlying trigger
Complications
- Cerebral edema (especially in children)
- Severe hypokalemia
- Hypoglycemia (iatrogenic)