Diabetic ketoacidosis

Also known as DKA.

Diabetes mellitus 

 

Symptoms

• Vomiting
• Abdominal pain
• Polyuria
• Polydipsia
• Dyspnoea
• Weakness
• Confusion

 

Signs

• Kussmaul breathing
• Fruity breath (due to exhalation of volatile ketones)
• Low and falling GCS

 

Comparison to hyperosmolar hyperglycaemic state

Similarities

• Insufficient insulin signalling in DKA and HHS
• Severe hyperglycaemia in DKA and HHS

Differences

•  Endogenous insulin levels are lower in DKA
•  Lipolysis is not suppressed by endogenous insulin in DKA
•  Elevated lipolysis and ketogenesis occur in DKA
•  Ketoacidosis develops in DKA
•  DKA is more likely in T1D, HHS is more likely in T2D

 

Complications

• Severe dehydration
• Hypokalaemia (secondary to insulin administration)
• Diabetic coma

 

Comparison with diabetic hypoglycaemia

• DKA is less common than DHG
• High blood glucose in DKA
• Slower onset of DKA
• Dry, warm in DKA
• Deep or rapid respirations in DKA
• Normal or low blood pressure in DKA
• Breath odour of ketone/acetone in DKA
• Seizures uncommon in DKA
• Severe dehydration in DKA
• Urine output excessive in DKA
• Awake, weak, tired in DKA
• Gradual recovery after treatment of DKA

Management

• IV fluids
• Insulin
• K+ infusion