Diabetic Ketoacidosis

Diabetic Ketoacidosis

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Insulinopaenia is an alteration of metabolism that results in the use of alternate fuel sources instead of glucose. This is the primary pathology of diabetes, which can also lead to the aetiology of Type 1 Diabetes Mellitus.


The onset of insulinopaenia can be due to Type 1 Diabetes Mellitus presentation, pre-existing cases of diabetes due to lack of insulin or an intercurrent infection.


  • Polyuria
  • Polydipsia
  • Weight loss
  • Nausea
  • Vomiting
  • Lethargy
  • Abdominal pain
  • Headache


  • Dehydration
  • A "pear drop" smell on the breath
  • Tachypnoea
  • Kussmaul's breathing
  • Drowsiness
  • Coma
  • Hypotension


  • Full blood count
  • Urea and electrolyte levels
  • Liver function tests
  • Ketone levels
  • Glucose level of more than 11 mmol/L
  • Venous Blood Gas (Blood PH 7.3, Venous HCO3 15)
  • ECG to check for ischaemia or infarction
  • MSU to check for infection and ketones
  • Chest X-ray to look for infection
  • CT head if low GCS is prolonged


Treatment involves the use of the DKA protocol, which involves fixed rate IV insulin at 0.1 units/kg/hour, IV fluids of 4-6 litres/24 hours with the first two litres over three hours, potassium monitoring and replacement, and treatment of any intercurrent infections.

Resolution Criteria

When the venous PH is greater than 7.35, the HCO3 is higher than 18, and the serum ketones are lower than 0.3 mmol/L, resolution can be declared.


Mortality from insulinopaenia is 2-5% (up to 50% in the elderly), though more commonly it increases morbidity.


Generally, prognosis is good if the condition is recognised and treated appropriately.

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