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Diabetic Ketoacidosis

Daniel R. Matta, MD and Zelibeth Gutierrez, MD Reviewed 06/2022
 


BASICS

DESCRIPTION

  • A life-threatening medical emergency in diabetics, which most commonly occurs in patients with type 1 diabetes

  • Characterized by a biochemical triad of hyperglycemia, ketosis, and high...

DIAGNOSIS

  • Diagnostic criteria (1)[C]

    • Hyperglycemia (usually 250-800 mg/dL) as rapidly assessed on fingerstick glucose testing and confirmed on serum chemistry

    • Low HCO3 (usually ≤18 mEq/L)

    • Metabolic acid...

TREATMENT

Goals 
  • Fluid resuscitation

  • Resolution of anion gap acidosis and ketosis

  • Insulin therapy to normalize serum glucose

  • Correction of electrolytes

  • Identify and treat precipitating cause(s)

GENERAL MEASURES

ONGOING CARE

DIET

  • NPO initially, advance diet when nausea and vomiting are controlled.

  • Avoid foods with high glycemic index (e.g., soft drinks, fruit juice, white bread, added sugar, etc.).

PATIENT EDUCATION

CLINICAL PEARLS

  • DKA is defined by a classic clinical triad of hyperglycemia, ketosis and high anion gap metabolic acidosis.

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

REFERENCES

1
Karslioglu French E, Donihi AC, Korytkowski MT. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome: review of acute decompensated diabetes in adult patients. BMJ. 2019;365:I1114...

CODES

ICD10

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

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

  • E13.11 Other specified diabetes mellitus with ketoacidosis with coma

  • ...

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