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Understanding Diabetic Ketoacidosis (DKA)

Diabetic Ketoacidosis (DKA) is a life-threatening complication of diabetes characterized by hyperglycemia, ketosis, and metabolic acidosis, primarily affecting Type 1 diabetes. Management involves restoring fluid volume, correcting hyperglycemia and acidosis, and addressing electrolyte imbalances while treating underlying causes. Key risk factors include infections, missed insulin doses, and stress, with symptoms such as polyuria, nausea, and altered mental status.

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11 views16 pages

Understanding Diabetic Ketoacidosis (DKA)

Diabetic Ketoacidosis (DKA) is a life-threatening complication of diabetes characterized by hyperglycemia, ketosis, and metabolic acidosis, primarily affecting Type 1 diabetes. Management involves restoring fluid volume, correcting hyperglycemia and acidosis, and addressing electrolyte imbalances while treating underlying causes. Key risk factors include infections, missed insulin doses, and stress, with symptoms such as polyuria, nausea, and altered mental status.

Uploaded by

islamasaer27
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© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Diabetic Ketoacidosis (DKA)

A Medical Emergency in Diabetes


Presented by: Dina Elsayed
Emergency Department (ER)
Definition

• DKA is an acute, life-threatening complication of diabetes


mellitus.
• - Hyperglycemia
• - Ketosis
• - Metabolic acidosis
• Most common in Type 1 diabetes
Pathophysiology 🩺
• Insulin deficiency + counter-regulatory hormone excess →
• - ↑ Gluconeogenesis & lipolysis
• - Free fatty acids → ketone body production
• - Ketones → metabolic acidosis
• - Hyperglycemia → osmotic diuresis → dehydration
Risk Factors/Triggers 🩺
• - Infection (most common)
• - Missed insulin doses
• - New-onset diabetes
• - MI, surgery, stress
• - Medications (e.g., steroids, SGLT2 inhibitors)
Clinical Presentation

• - Polyuria, polydipsia, weight loss


• - Nausea, vomiting, abdominal pain
• - Dehydration, dry mucosa
• - Kussmaul respiration
• - Fruity breath
• - Altered mental status
Diagnostic Criteria (ADA)

• - Glucose > 250 mg/dL


• - Arterial pH < 7.3
• - Bicarbonate < 18 mEq/L
• - Positive serum/urine ketones
• - Increased anion gap
Laboratory Findings

• - Glucose: high
• - pH: low
• - Bicarbonate: low
• - Ketones: positive
• - K⁺: may be normal/high initially, then drops
• - Na⁺: pseudohyponatremia
• - Anion gap: elevated
Management Overview

• Goals:
• 1. Restore volume (fluids)
• 2. Correct hyperglycemia (insulin)
• 3. Correct acidosis/ketosis
• 4. Correct electrolytes (esp. K⁺)
• 5. Treat precipitating cause
Fluid Replacement

• - Initial: 0.9% NaCl at 1-1.5 L/hr


• - Adjust based on hydration & Na⁺
• - Switch to 5% dextrose when glucose < 200 mg/dL
Insulin Therapy

• - IV regular insulin:
• • Bolus: 0.1 units/kg (optional)
• • Infusion: 0.1 units/kg/hr
• - Goal: ↓ glucose 50–75 mg/dL/hr
Potassium Management

• - K⁺ < 3.3: Hold insulin, give K⁺


• - K⁺ 3.3–5.2: Add K⁺ to fluids
• - K⁺ > 5.2: Monitor every 2 hrs
Monitoring

• - Hourly: Glucose, vitals


• - q2–4h: Electrolytes, ABG, BUN/Cr
• - Monitor mental status & fluids
Complications

• - Cerebral edema (esp. children)


• - Hypokalemia
• - Hypoglycemia
• - Acute renal failure
• - Coma or death
Prevention

• - Education on sick-day rules


• - Adherence to insulin
• - Early symptom recognition
• - Ketone monitoring during illness
Summary

• - DKA = urgent, serious


• - Requires:
• • Fluids + insulin
• • Electrolyte correction
• • Treat cause
Questions

• Thank you!
• Any questions?

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