Diabetic Ketoacidosis

Diabetic Ketoacidosis

Pathology:                    Insulinopaeniacausing diversion of metabolism to use alternate fuel. Also see pathology ofdiabetes above.


Aetiology:                     Firstpresentation of Type1Diabetes Mellitus or in pre-existing diabetes from insulinomission/failed therapy or intercurrent infection.


Symptoms:                   Polyuria,polydipsia, weight loss, nausea, vomiting, lethargy, abdominal pain, headache


Signs:                              Dehydration“pear drop” smell on breath, tachypnoea, Kussmaul’s breathing, drowsiness, coma,hypotension


Investigations:          Bloods: FBC, U&Es, LFTs, ketonesand Glucose (>11mmol/L)

VenousBlood Gas: Blood PH≤7.3, Venous HCO3≤15

ECG: Ruleout ischaemia or infarction

MSU: Screenfor infection and screen for ketones

ChestX-Ray: Screen for infection

                                       CT Head: ifprolonged low GCS


Treatment:                  DKA protocol Fixed rate IV insulin at0.1 units/Kg/Hr, IV fluids 4-6 litres/24

 hours with 1sttwo litres over 3 hours, potassium monitoring and

 replacement, and treatment of anyintercurrent infections

Resolutioncriteria: Venous PH>7.35, HCO3>18, and serum ketones <0.3



Complications:          Mortality2-5% (up to 50% in elderly). More commonly causes increased morbidity


Prognosis:                    As above, usually good ifrecognised and treated appropriately

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