DIABETIC KETOACIDOSIS (DKA)

Essentials to diagnosis

+ metabolic acidosis (Venous Blood gas is sufficient)

Differential Diagnosis - altered mental state and metabolic acidosis

See Coma

See Poisonings and metabolic acidosis

Pathogenesis

Relative insulin deficiency causes:

resulting in:

Clinical Manifestations

  EARLY MIDDLE LATE
HISTORY Malaise
Nausea
Polydipsia
Polyuria
Polyphagia
Vomiting
Abdominal pain
Dyspnoea
Drowsiness  (proportional to the serum osmolality)
Coma
EXAMINATION Dehydration
Acetone breath
Deep, rapid, and intense breathing
Tachycardia
Fever/Hypothermia (suggests underlying infection)
Abdominal tenderness (resolves with treatment otherwise consider surgical abdomen)
Kussmaul pattern consisting of deep, sighing respirations
Depressed sensorium
Hypotension

Resuscitation

Investigations

Consider CXR, ECG, CK, blood cultures – looking for precipitants

Definitive Management

Treat Cause

Infection is commonest cause (fever not always present)

Fluid management

Unproven association between excess fluid administration and development of cerebral oedema

Treat acidosis

Glucose (mmol/L) Insulin (Units/hr)
0 - 5 Nil
5.1 – 10 1
10.1 – 15 2
15.1 – 20 4
> 20 8

Unproven association between excess insulin administration and development of cerebral oedema

Potassium replacement

Phosphate/Magnesium replacement

Treat complications

Monitoring

Poor Prognostic Factors

Disposal