Advertisement

Diabetic Ketoacidosis

  • Hira Bakhtiar
  • Robyn ScatenaEmail author
Chapter
  • 1 Downloads

Abstract

Diabetic ketoacidosis (DKA) is characterized by hyperglycemia, metabolic acidosis, ketone production, and severe volume depletion. There is considerable variability in the presentation of DKA, ranging from euglycemia and acidosis to severe hyperglycemia. Initial evaluation should include identification of precipitating factors. Treatment of DKA requires correction of hyperglycemia with intravenous insulin infusions, frequent monitoring and replacement of electrolytes, correction of hypovolemia with intravenous fluids, and possible correction of acidosis. Electrolyte levels must be monitored carefully during treatment as life-threatening hypokalemia or hypophosphatemia may develop. Sodium bicarbonate is reserved for the initial treatment of extreme acidemia. Milder cases of DKA may be safely treated outside of the ICU setting with subcutaneous insulin.

Keywords

DKA Diabetic ketoacidosis Euglycemic DKA Diabetes Insulin Fluid resuscitation Potassium Bicarbonate Cerebral edema 

References

  1. 1.
    Kitabchi AE, Umpierrez GE, Murphy MB, et al. Hyperglycemic crises in diabetes. Diabetes Care. 2004;27(Suppl 1):S94–102.PubMedGoogle Scholar
  2. 2.
    Arora S, Henderson SO, Long T, Menchine M. Diagnostic accuracy of point-of-care testing for diabetic ketoacidosis at emergency-department triage: {beta}-hydroxybutyrate versus the urine dipstick. Diabetes Care. 2011;34(4):852–4.PubMedPubMedCentralCrossRefGoogle Scholar
  3. 3.
    Westerberg DP. Diabetic ketoacidosis: evaluation and treatment. Am Fam Physician. 2013;87(5):337–46.PubMedGoogle Scholar
  4. 4.
    Nair S, Yadav D, Pitchumoni CS. Association of diabetic ketoacidosis and acute pancreatitis: observations in 100 consecutive episodes of DKA. Am J Gastroenterol. 2000;95(10):2795–800.PubMedCrossRefGoogle Scholar
  5. 5.
    Yadav D, Nair S, Norkus EP, Pitchumoni CS. Nonspecific hyperamylasemia and hyperlipasemia in diabetic ketoacidosis: incidence and correlation with biochemical abnormalities. Am J Gastroenterol. 2000;95(11):3123–8.PubMedCrossRefGoogle Scholar
  6. 6.
    Newton C, Raskin P. Diabetic ketoacidosis in type 1 and type 2 diabetes mellitus. Arch Intern Med. 2004;164(17):1925–31.PubMedCrossRefGoogle Scholar
  7. 7.
    Basu A, Close C, Jenkins D, Krentz A, Nattrass M, Wright A. Persisting mortality in diabetic ketoacidosis. Diabet Med. 1993;10(3):282–4.PubMedCrossRefGoogle Scholar
  8. 8.
    Spears B. Deaths associated with diabetic ketoacidosis and hyperosmolar coma. Ann Emerg Med. 1990;19(6):726.CrossRefGoogle Scholar
  9. 9.
    Hillman K. Fluid resuscitation in diabetic emergencies – a reappraisal. Intensive Care Med. 1987;13(1):4–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Hillier T, Abbott R, Barrett E. Hyponatremia: evaluating the correction factor for hyperglycemia. Am J Med. 1999;106(4):399–403.PubMedCrossRefGoogle Scholar
  11. 11.
    Wilson H. Phosphate therapy in diabetic ketoacidosis. Arch Intern Med. 1982;142(3):517–20.PubMedCrossRefGoogle Scholar
  12. 12.
    Fisher J, Kitabchi A. A randomized study of phosphate therapy in the treatment of diabetic ketoacidosis∗. J Clin Endocrinol Metab. 1983;57(1):177–80.PubMedCrossRefGoogle Scholar
  13. 13.
    Winter RJ, Harris CJ, Phillips LS, Green OC. Diabetic ketoacidosis. Induction of hypocalcemia and hypomagnesemia by phosphate therapy. Am J Med. 1979;67(5):897–900.PubMedCrossRefGoogle Scholar
  14. 14.
    Musey V, Lee J, Crawford R, Klatka M, McAdams D, Phillips L. Diabetes in urban African-Americans. I. Cessation of insulin therapy is the major precipitating cause of diabetic ketoacidosis. Diabetes Care. 1995;18(4):483–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Slovis CM, Mork VG, Slovis RJ, Bain RP. Diabetic ketoacidosis and infection: Leukocyte count and differential as early predictors of serious infection. J Emerg Med. 1987;5(1):1–5.CrossRefGoogle Scholar
  16. 16.
    Chan N, Manchanda S, Feher M, Morgan D. Fatal cerebral oedema associated with hyponatraemia in adult diabetic ketoacidosis. Pract Diabet Int. 1998;15(7):209–11.CrossRefGoogle Scholar
  17. 17.
    Troy P, Clark R, Kakarala S, Burns J, Silverman I, Shore E. Cerebral edema during treatment of diabetic ketoacidosis in an adult with new onset diabetes. Neurocrit Care. 2005;2(1):055–8.CrossRefGoogle Scholar
  18. 18.
    Curtis J, Bohn D, Daneman D. Use of hypertonic saline in the treatment of cerebral edema in diabetic ketoacidosis (DKA). Pediatr Diabetes. 2001;2(4):191–4.PubMedCrossRefGoogle Scholar
  19. 19.
    Sprung C. Pulmonary edema; a complication of diabetic ketoacidosis. Chest. 1980;77(5):687–8.PubMedCrossRefGoogle Scholar
  20. 20.
    Powner D. Altered pulmonary capillary permeability complicating recovery from diabetic ketoacidosis. Chest. 1975;68(2):253–6.PubMedCrossRefGoogle Scholar
  21. 21.
    Brun-Buisson C, Bonnet F, Bergeret S, Lemaire F, Rapin M. Recurrent high-permeability pulmonary edema associated with diabetic ketoacidosis. Crit Care Med. 1985;13(1):55–6.PubMedCrossRefGoogle Scholar
  22. 22.
    Viallon A, Zeni F, Lafond P, et al. Does bicarbonate therapy improve the management of severe diabetic ketoacidosis? Crit Care Med. 1999;27(12):2690–3.PubMedCrossRefGoogle Scholar
  23. 23.
    Morris LR, Murphy MB, Kitabchi AE. Bicarbonate therapy in severe diabetic ketoacidosis. Ann Intern Med. 1986;105(6):836–40.PubMedCrossRefGoogle Scholar
  24. 24.
    Chua HR, Schneider A, Bellomo R. Bicarbonate in diabetic ketoacidosis – a systematic review. Ann Intensive Care. 2011;1(1):23.PubMedPubMedCentralCrossRefGoogle Scholar
  25. 25.
    Umpierrez G, Latif K, Stoever J, et al. Efficacy of subcutaneous insulin lispro versus continuous intravenous regular insulin for the treatment of patients with diabetic ketoacidosis. Am J Med. 2004;117(5):291–6.PubMedCrossRefGoogle Scholar
  26. 26.
    Umpierrez G, Cuervo R, Karabell A, Latif K, Freire A, Kitabchi A. Treatment of diabetic ketoacidosis with subcutaneous insulin aspart. Diabetes Care. 2004;27(8):1873–8.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Internal Medicine, Pulmonary and Critical SectionNorwalk HospitalNorwalkUSA

Personalised recommendations