09/06/2025
Understanding Diabetic Ketoacidosis (DKA)💉🩺👇
A life-threatening complication of diabetes mellitus (mainly type 1, but can occur in type 2) caused by insulin deficiency and increased counter-regulatory hormones → leading to hyperglycemia, ketosis, and metabolic acidosis.
🛑Causes / Triggers
• Infection (most common trigger)
• Missed insulin doses
• Myocardial infarction, stroke, trauma, surgery
• Medications (steroids, thiazides, sympathomimetics)
• New-onset type 1 diabetes
🛑Pathophysiology
• ↓ Insulin + ↑ glucagon, cortisol, catecholamines → breakdown of fat → free fatty acids → ketone body production (acetoacetate, β-hydroxybutyrate).
• Ketones → metabolic acidosis.
• Hyperglycemia → osmotic diuresis → dehydration, electrolyte loss.
🛑Clinical Features
Symptoms:
• Polyuria, polydipsia, weight loss
• Abdominal pain, nausea, vomiting
• Altered mental status (confusion → coma)
Signs:
• Dehydration (dry skin, sunken eyes, hypotension, tachycardia)
• Kussmaul respiration (deep, rapid breathing)
• Fruity (acetone) breath odor
🛑Diagnostic Criteria (ADA)
• Blood glucose > 250 mg/dL (>13.9 mmol/L)
• Arterial pH < 7.3
• Bicarbonate < 18 mmol/L
• Positive ketones (blood or urine)
• Anion gap metabolic acidosis
🛑Management (Emergency 🚨)
A. Initial Stabilization
• Airway, Breathing, Circulation (ABC)
• Oxygen if hypoxic
• Monitor vitals, urine output, cardiac monitoring
B. Fluid Replacement
• 0.9% Normal Saline IV (1 L in first hour), then adjust based on hydration and sodium.
C. Insulin Therapy
• Regular insulin IV infusion (0.1 units/kg/hour) after fluids.
• Continue until ketones clear & acidosis resolved.
D. Electrolyte Management
• Potassium:
• If K+ ❤.3 → replace before giving insulin.
• If 3.3–5.5 → give insulin + K+.
• If >5.5 → give insulin, monitor K+.
• Monitor sodium, phosphate, magnesium.
E. Address Underlying Cause
• Treat infection, stop precipitating drugs, manage MI/stroke, etc.
🛑Complications
• Hypokalemia (from insulin + fluids)
• Hypoglycemia (if insulin not balanced with dextrose later)
• Cerebral edema (more common in children)
• ARDS, shock, coma, death if untreated
🛑Prevention
• Good diabetes control (regular insulin use)
• Sick day rules (monitor glucose & ketones closely during illness)
• Patient education on early warning signs (nausea, vomiting, fruity breath, rapid breathing)
⚠️DKA is a medical emergency → requires ICU or emergency care with close monitoring of fluids, electrolytes, insulin, and underlying cause.
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