Skip to main content

Diabetic Ketoacidosis

Melanie J. Lippmann, MD Reviewed 06/2018
 


BASICS

DESCRIPTION

  • A life-threatening medical emergency in diabetics secondary to insulin deficiency and characterized by hyperglycemia, ketosis, metabolic acidosis, electrolyte disturbances, and marke...

DIAGNOSIS

HISTORY

  • Recent illness, injury, or surgery

  • Changes in diet or medications

  • Missed insulin doses/ noncompliance

  • Insulin pump failure

  • Weight loss in patients recently diagnosed with type 1 DM

  • Polyuri...

TREATMENT

  • Oxygen and airway management, as needed

  • Establish IV access.

  • Cardiac monitoring

  • Start isotonic crystalloid solution (e.g., 0.9% saline, or lactated ringers bolus).

GENERAL MEASURES

  • All, but mild ...

ONGOING CARE

FOLLOW UP RECOMMENDATIONS

Patient Monitoring

  • Monitor mental status, vital signs, and urine output q30–60min until improved, then q2–4h.

  • Monitor blood sugar q1h until <200 mg/dL, then q2–6...

REFERENCES

1
1 Kitabchi AE, Umpierrez GE, Miles JM, et al. Hyperglycemic crises in adult patients with diabetes. Diabetes Care.  2009;32(7):1335–1343. {L-End} {L-End} [View Abstract on OvidMedl...

ADDITIONAL READING

  • American Diabetes Association. Standards of medical care in diabetes—2013. Diabetes Care.  2013;36(Suppl 1):S11–S66. {L-End} {L-End} [View Abstract on OvidMedline]

  • Sheikh-Ali...

SEE ALSO

  • Diabetes Mellitus, Type 1

  • Algorithm: Diabetic Ketoacidosis (DKA), Treatment

CODES

ICD10

  • E10.10 Type 1 diabetes mellitus with ketoacidosis without coma

  • E13.10 Oth diabetes mellitus with ketoacidosis without coma

  • E10.11 Type 1 diabetes mellitus with ketoacidosis with coma

  • E13.11 Ot...

CLINICAL PEARLS

  • Admit if blood glucose >250 mg/dL, pH <7.3, HCO3 ≤15 mEq/L, and ketones in urine.

  • Potassium is falsely elevated due to acidosis; start replacement when K+ ≤5.2 mg/dL and urine out...

Subscribe to Access Full Content

Sign Up for a 10-Day Free Trial

Sign up for a 10-day FREE Trial now and receive full access to all content.

 
×