SHM's Clinical Quick Talks-Diabetic Ketoacidosis (DKA)

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Diabetic Ketoacidosis (DKA) is a condition characterized by elevated glucose levels, the presence of ketones, and metabolic acidosis. It occurs primarily in Type 1 diabetes patients, but can also occur in Type 2 diabetes. DKA is triggered by factors such as insulin omission, infection, ischemia, intra-abdominal issues, and ingested substances. The pathophysiology involves an increase in glucose levels due to gluconeogenesis, glycogenolysis, and impaired glucose utilization. The lack of insulin leads to the secretion of counter-regulatory hormones, which promote the breakdown of fat and muscle, resulting in the production of ketones.<br /><br />The clinical presentation of DKA includes symptoms such as polyuria, polydipsia, polyphagia, fatigue, muscle cramps, flushed facial appearance, Kussmaul's respirations, dyspnea, nausea, vomiting, abdominal pain, dehydration, hypotension, shock, altered consciousness, and coma. Diagnostic workup often involves basic metabolic panel, urinary glucose and ketones, ABG, and additional tests depending on the clinical scenario.<br /><br />Treatment for DKA includes volume resuscitation using intravenous fluids, monitoring glucose levels, electrolyte replacement, and administration of insulin. Insulin helps in reducing blood glucose levels and ketones by reducing lipolysis and glucagon release. Close monitoring is essential to ensure proper treatment and to gauge the end point of treatment, such as closed anion gap, blood sugar levels around 200, and the initiation of subcutaneous insulin.<br /><br />Additionally, an atypical form of DKA called DKA in atypical patients presents in individuals who are not completely insulin deficient. This form shares features with both Type 1 and Type 2 diabetes and may not require long-term insulin treatment.<br /><br />It is important to differentiate DKA from another condition called Hyperosmolar Hyperglycemic State (HHS). The management and pathophysiology of the two conditions are different.<br /><br />Overall, the treatment of DKA involves identifying and addressing the underlying trigger, replacing intravascular volume, correcting electrolyte imbalances, and administering insulin as necessary.

Asset Subtitle

Leigh Vaughn

Keywords

Diabetic Ketoacidosis

DKA

elevated glucose levels

ketones

metabolic acidosis

Type 1 diabetes

Type 2 diabetes

insulin omission

gluconeogenesis

glycogenolysis