Diabetic ketoacidosis in adultsBMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h5660 (Published 28 October 2015) Cite this as: BMJ 2015;351:h5660
- Shivani Misra, clinical research fellow and specialist trainee year 6 in metabolic medicine12,
- Nick S Oliver, consulant diabetologist and reader in diabetes13
- 1Department of Diabetes, Endocrinology & Metabolism, Imperial College, London W2 1PG, UK
- 2Clinical Biochemistry & Metabolic Medicine, Imperial Healthcare NHS Trust, London, UK
- 3Diabetes and Endocrinology, Imperial Healthcare NHS Trust, London, UK
- Correspondence to: N S Oliver
What you should know
Diabetic ketoacidosis (DKA) is a common, serious, and preventable complication of type 1 diabetes, with a mortality of 3-5%. It can also occur in patients with other types of diabetes
It can be the first presentation of diabetes. This accounts for about 6% of cases
The diagnosis is not always apparent and should be considered in anyone with diabetes who is unwell
Diagnosis is based on biochemical criteria. However, hyperglycaemia may not always be present and low blood ketone levels (<3 mmol/L) do not always exclude DKA
Immediate treatment consists of intravenous fluids, insulin, and potassium, with careful monitoring of blood glucose and potassium levels to avoid hypoglycaemia and hypokalaemia
Knowledge of the type of diabetes at the time of DKA does not affect immediate treatment, and all patients with DKA should be advised to continue with insulin on discharge
Subsequent management should focus on patient education and support to avoid recurrence
Patients should be managed by a specialist multidisciplinary team during and after an episode of DKA
What is DKA?
Diabetic ketoacidosis (DKA) is an extreme metabolic state caused by insulin deficiency. The breakdown of fatty acids (lipolysis) produces ketone bodies (ketogenesis), which are acidic. Acidosis occurs when ketone levels exceed the body’s buffering capacity (figure⇓).1 2
How common is DKA?
Data from the UK National Diabetes audit shows a crude one year incidence of 3.6% among people with type 1 diabetes.3 In the UK nearly 4% of people with type 1 diabetes experience DKA …
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