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
mmol/L)
Complications: Mortality2-5% (up to 50% in elderly). More commonly causes increased morbidity
Prognosis: As above, usually good ifrecognised and treated appropriately
