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Diabetic Ketoacidosis

Aka: Diabetic Ketoacidosis, DKA
  1. See Also
    1. Diabetic Ketoacidosis Management in Adults
    2. Diabetic Ketoacidosis Management in Children
  2. Precipitating Factors
    1. Uncontrolled or new onset Diabetes Mellitus
    2. Myocardial Infarction
    3. Pregnancy
    4. Infection
      1. Septic Shock
      2. Urinary Tract Infection
      3. Pneumonia
  3. Symptoms
    1. Rapid onset of symptoms
    2. Weakness
    3. Nausea and Vomiting (50-80% of cases)
    4. Lethargy
    5. Abdominal Pain (30% of patients)
  4. Signs
    1. Mental clouding
    2. Kussmaul breathing
    3. Acetone on breath
    4. Dehydration (often >10% dehydrated)
      1. Dry Skin with loss of Skin Turgor
      2. Eyes sunken
      3. Tachycardia and possibly Hypotension
    5. Temperature below normal
  5. Labs
    1. Bedside Glucose
    2. Urinalysis
      1. Glucosuria
      2. Ketonuria
        1. Highly sensitive for Diabetic Ketoacidosis
        2. High Negative Predictive Value
        3. Negative Urine Ketone excludes DKA diagnosis
        4. Schwab (1999) Ann Emerg Med 34:342-6
    3. Chemistry Panel (Chem8)
      1. Serum Glucose increased (Hyperglycemia)
      2. Serum Sodium decreased (Hyponatremia)
      3. Serum Chloride depressed (Hypochloremia)
      4. Serum Bicarbonate depressed
      5. Anion Gap elevated (>10 to 12)
      6. Serum Phosphorus decreased (Hypophosphatemia)
      7. Serum Magnesium decreased (Hypomagnesemia)
      8. Serum Osmolality (calculate and measure if available)
        1. Should be >320 mOsm/kg if DKA present
    4. Arterial Blood Gas (ABG)
      1. Metabolic Acidosis
    5. Beta hydroxybutyrate or Serum Ketones
    6. Precipitating factor evaluation
      1. Complete Blood Count with differential
      2. Blood Culture
      3. Urine Culture
      4. Chest XRay
      5. Electrocardiogram (EKG)
        1. Indicated over age 40 or over 10 years of Diabetes
    7. Evaluation of Diabetes and Endocrine Status
      1. Hemoglobin A1C
      2. Anti-GAD65 Antibody (identifies Type I diabetics)
      3. Thyroid Stimulating Hormone (TSH)
  6. Diagnostic Criteria: Hyperglycemia, Ketosis, Acidosis
    1. Blood Glucose exceeds 250 mg/dl
    2. Metabolic Acidosis
      1. Serum pH < 7.30
      2. Serum Bicarbonate < 15 meq/L
    3. Moderate Ketonuria or Ketonemia
      1. Serum Ketones exceed 1:2 dilution
    4. Anion Gap elevated
  7. Evaluation: Severity
    1. Arterial pH
      1. Mild: 7.25 to 7.30
      2. Moderate: 7.00 to 7.24
      3. Severe: < 7.00
    2. Serum bicarbonate
      1. Mild: 15-18
      2. Moderate: 10 to 14
      3. Severe: < 10
    3. Mental status
      1. Mild: Alert
      2. Moderate: Drowsy
      3. Severe: Stupor
  8. Indications for home management
    1. Mild Diabetic Ketoacidosis and
    2. Alert mental status and
    3. Taking oral fluids
  9. Management
    1. See Diabetic Ketoacidosis Management in Adults
    2. See Diabetic Ketoacidosis Management in Children
  10. Complications
    1. Metabolic Complications
      1. Severe Metabolic Acidosis
      2. Hypokalemia
      3. Hypoglycemia
      4. Hypocalcemia
    2. Non-metabolic Complications
      1. Septic Shock
      2. Hypovolemic Shock
      3. Vascular Thrombosis
      4. Pulmonary edema (aggressive rehydration)
      5. Cerebral edema
  11. Prevention of Diabetic Ketoacidosis
    1. Diabetic action plan based on Blood Glucose Monitoring
      1. Home monitoring of beta hydroxybutyrate or ketones
      2. Plan for supplementing short acting Insulin
        1. Sick day Insulin coverage
        2. Liquid diets when sick
    2. Case management
      1. Diabetic educator
      2. Frequent phone contact
    3. Consider Insulin pump
  12. References
    1. Orland in Stine (1994) Emergency Med, p. 204-5
    2. Chiasson (2003) CMAJ 168:859-66
    3. Kitabchi (2001) Diabetes Care 24:131-53
    4. Trachtenbarg (2005) Am Fam Physician 71(9): 1705-22
    5. Trence (2001) Endocrinol Metab Clin North Am 30:817-31

Diabetic Ketoacidosis (C0011880)

Definition (NCI) A type of metabolic acidosis produced by accumulation of ketone bodies resulting from uncontrolled diabetes mellitus.
Definition (MSH) A life-threatening complication of diabetes mellitus, primarily of TYPE 1 DIABETES MELLITUS with severe INSULIN deficiency and extreme HYPERGLYCEMIA. It is characterized by KETOSIS; DEHYDRATION; and depressed consciousness leading to COMA.
Definition (CHV) a serious complication of diabetes mellitus
Definition (CHV) a serious complication of diabetes mellitus
Definition (CHV) a serious complication of diabetes mellitus
Definition (CSP) complication of diabetes resulting from severe insulin deficiency coupled with an absolute or relative increase in glucagon concentration; metabolic acidosis is caused by the breakdown of adipose stores and resulting increased levels of free fatty acids; glucagon accelerates the oxidation of the free fatty acids producing excess ketone bodies (ketosis).
Definition (NCI) The metabolic condition resulted from uncontrolled diabetes mellitus, in which the shift of acid-base status of the body toward the acid side because of loss of base or retention of acids other than carbonic acid is accompanied by the accumulation of ketone bodies in body tissues and fluids.
Concepts Disease or Syndrome (T047)
MSH D016883
ICD9 250.1
SnomedCT 24927004, 420422005, 154671004, 267467004, 190328004
English Diabetic keto-acidosis, Acidoses, Diabetic, Acidosis, Diabetic, Diabetic Acidoses, Diabetic Acidosis, Diabetic Ketoacidoses, Ketoacidoses, Diabetic, Ketoacidosis, Diabetic, Diabetes with ketoacidosis, ACIDOSIS DIABETIC, ACIDOSIS, DIABETIC, DIABETIC ACIDOSIS, DIABETIC KETOACIDOSIS, DKA, diabetic acidosis, Diabetes Mellitus with Ketoacidosis, Diabetic acidosis without coma, Diabetic ketosis without coma, DKA - Diabetic ketoacidosis, Diab.mell.+ketoacid -onset NOS, Diabetes mellitus NOS with ketoacidosis, Diabetic acidosis, NOS, Diabetic ketoacidosis, Diabetes mellitus with ketoacidosis, Diabetic acidosis, Diabetes with ketoacidosis (disorder), Ketoacidosis in diabetes mellitus (disorder), Ketoacidosis in diabetes mellitus, Diab.mell.with ketoacidosis, diabetes with ketoacidosis, diabetes mellitus with ketoacidosis, diabetes mellitus with ketoacidosis (diagnosis), Diabetes mellitus (& [ketoacidosis]) (disorder), Acidosis diabetic, Ketoacidosis (diabetic), Diabetic ketosis, KETOACIDOSIS DIABETIC, Diabetes mellitus NOS with ketoacidosis (disorder), KETOACIDOSIS, DIABETIC, Diabetic Ketoacidosis [Disease/Finding], diabetic ketoacidosis, diabetic ketoacidoses, diabetic ketosis, diabetic ketoses, Diabetes mellitus (& [ketoacidosis]), Ketoacidosis - diabetic, Diabetic Ketoses, Diabetic Ketosis, Ketoses, Diabetic, Ketosis, Diabetic, Diabetic Ketoacidosis
French ACIDOCETOSE DIABETIQUE, Diabète sucré avec kétoacidose, Kétoacidose (diabétique), Diabète avec kétoacidose, Acidocétose diabétique, Acidose diabétique, Cétose diabétique, Acido-cétose diabétique
Portuguese CETOACIDOSE DIABETICA, Acidose diabética, Diabetes com cetacidose, Cetacidose diabética, Diabetes mellitus com cetacidose, Cetose diabética, Cetoacidose diabética, Acidose Diabética, Cetoacidose Diabética, Cetose Diabética
Spanish CETOACIDOSIS DIABETICA, diabetes mellitus con cetoacidosis, cetoacidosis diabética, cetoacidosis en diabetes mellitus, cetoacidosis en diabetes mellitus (trastorno), Diabetes mellitus con cetoacidosis, Acidosis diabética, Cetosis diabética, Cetoacidosis (diabética), Diabetes con cetoacidosis, acidosis diabética, diabetes con cetoacidosis, cetoacidosis diabética (trastorno), Diabetic ketoacidosis, Ketoacidosis - diabetic, Diabetes mellitus (& [ketoacidosis]), diabetes mellitus, SAI con cetoacidosis (trastorno), diabetes mellitus, SAI con cetoacidosis, Cetoacidosis diabética, Acidosis Diabética, Cetoacidosis Diabética, Cetosis Diabética, Acidosis Diabetica, Cetoacidosis Diabetica, Cetosis Diabetica
German DIABETISCHE KETOAZIDOSE, Diabetes mellitus mit Ketoazidose, Azidose, diabetisch, Ketoazidose (diabetisch), diabetische Azidose, diabetische Ketose, Diabetes mit Ketoazidose, diabetische Ketoazidose, Azidose, diabetische, Diabetische Azidose, Diabetische Ketoazidose, Ketoazidose, diabetische
Dutch diabetes mellitus met ketoacidose, diabetische ketose, diabetes met ketoacidose, diabetische acidose, ketoacidose (diabetisch), acidose diabetisch, diabetische ketoacidose, Acidose, diabetische, Diabetische acidose, Diabetische ketoacidose, Diabetische ketose, Ketoacidose, diabetische, Ketose, diabetische
Italian Diabete mellito con chetoacidosi, Chetoacidosi (diabetica), Diabete con chetoacidosi, Chetosi diabetica, Acidosi diabetica, Chetoacidosi diabetica
Japanese ケトアシドーシスを伴う糖尿病, ケトアシドーシス(糖尿病性), ケトアシドーシストウニョウビョウセイ, トウニョウビョウセイアシドーシス, ケトアシドーシスヲトモナウトウニョウビョウ, トウニョウビョウセイケトアシドーシス, トウニョウビョウセイケトーシス, 糖尿病性アシドーシス, 糖尿病性ケトーシス, ケトーシス-糖尿病性, 糖尿病ケトアシドーシス, ケトアシドーシス-糖尿病性, アシドーシス-糖尿病性, 糖尿病性ケトアシドーシス
Swedish Diabetesketoacidos
Czech diabetická ketoacidóza, diabetická ketóza, Diabetes mellitus s ketoacidózou, Diabetická ketóza, Diabetická ketoacidóza, Diabetická acidóza, Diabetes s ketoacidózou, Ketoacidóza (diabetická)
Finnish Diabeettinen ketoasidoosi
Russian DIABETICHESKII ATSIDOZ, ATSIDOZ DIABETICHESKII, DIABETICHESKII KETOATSIDOZ, DIABETICHESKII KETOZ, KETOATSIDOZ DIABETICHESKII, KETOZ DIABETICHESKII, АЦИДОЗ ДИАБЕТИЧЕСКИЙ, ДИАБЕТИЧЕСКИЙ АЦИДОЗ, ДИАБЕТИЧЕСКИЙ КЕТОАЦИДОЗ, ДИАБЕТИЧЕСКИЙ КЕТОЗ, КЕТОАЦИДОЗ ДИАБЕТИЧЕСКИЙ, КЕТОЗ ДИАБЕТИЧЕСКИЙ
Croatian DIJABETIČNA KETOACIDOZA
Polish Kwasica cukrzycowa, Ketoza cukrzycowa, Kwasica ketonowa cukrzycowa
Hungarian Diabéteszes acidózis, Diabetes mellitus ketoacidosissal, Diabetes ketoacidosissal, Diabeteses acidosis, Diabeteses ketosis, Diabeteses ketoacidosis, Ketoacidosis (diabeteses)
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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