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Diabetic Ketoacidosis, Emergency Medicine

Joseph M. Weber Reviewed 06/2017



Insulin deficiency and excess of counterregulatory hormones (catecholamines, glucagon, growth hormone, and cortisol) resulting in: 
  • Dehydration (osmotic, hyperglycemic, diuresis, and ...


Signs and Symptoms


  • Medication noncompliance

  • Polyuria, polydipsia

  • Weakness

  • Abdominal pain, nausea, vomiting

  • Altered mental status

  • Chest pain

  • Febrile illness

Physical Exam

  • Tachycardia

  • Hypotension...



  • Fluid bolus often initiated in field

  • Quantify amount given by paramedics to guide further ED fluids.

Initial Stabilization/Therapy

  • ABCs for patients with altered mental status

  • Coma c...



Admission Criteria

  • ICU admission for pH <7, altered mental status, serious comorbid illness, and extremes of age (<2 yr or >60 yr)

  • Monitored unit for moderate DKA (pH 7.01–...

Pearls and Pitfalls

  • Decreasing or discontinuing insulin drip when glucose normalizes is a pitfall. Insulin should only be stopped when pH improves and anion gap normalizes.

  • Failure to replete potassium...

Additional Reading

  • Goyal  N, Miller  JB, Sankey  SS, et al. Utility of initial bolus insulin in the treatment of diabetic ketoacidosis. J Emerg Med.  2010;38(4):422–427.

  • Kitabchi  AE, Umpierrez  G...



  • 250.10 type II diabetes mellitus [non-insulin dependent type] [NIDDM type] [adult-onset type] or unspecified type, not stated as uncontrolled, with ketoacidosis

  • 250.11 type I diabetes mellitu...

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