Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is characterized by hyperglycemia, ketonemia and acidemia, with rapid symptom onset.

Most common precipitating cause for DKA is non compliance with insulin regimen. Other precipitating factors include infections, dehydration and other stressful conditions.

Clinical features include weakness, abdominal pain, vomiting, tachycardia, tachypnea (Kussmaul breathing), acidotic breath,  dry mucous membranes, poor skin turgor and hypotension. If cerebral edema has set in there may be altered mental status, seizures and abnormal neurological findings such as brisk knee jerks.

Treatment includes correction of volume depletion and insulin therapy. Special attention should be paid to electrolyte imbalances especially sodium and potassium. Potassium will fall with insulin therapy and will need to be replaced. Sodium will be falsely low in setting of hyperglycemia. Corrected sodium can be calculated as Measured sodium + 0/016x(Current glucose-150). In other words increase sodium by 1.6 for every 100mg/dl of glucose above 100.

End points for treatment:


Plasma glucose less than 200 mg/dL
Serum bicarbonate more than 18 mEq/L
Venous pH more than 7.3
Anion gap more than 10.

No vomiting/pain and able to eat PO

Urine ketones may persist at this point and some physicians will continue patients on IVF while urine has ketones.