Diabetic ketoacidosis

DKA is an acute metabolic complication occurring mostly in patients with T1DM, characterized by a triad of hyperglycemia, ketosis, and acidemia.

DKA is caused by absolute or relative insulin deficiency and increased levels of counterregulatory hormones, typically ocurring at the time of new diagnosis of untreated T1DM or due to inadequate insulin therapy, infection (such as pneumonia, UTI, sepsis), concomitant medications (corticosteroids, SGLT-2 inhibitors, thiazide diuretics, sympathomimetics, certain antipsychotics), illicit drug use, surgery, trauma, physiologic stress, or pregnancy.

The age-adjusted hospitalization rate for DKA in the US was estimated at 6.3% annually in 2014, with an in-hospital case fatality of 0.4%. The rate of hopsitalization for DKA per 10,000 admissions was reported as 53.4 in 2014 and 61.6 in 2017.

Risk factors include inconsistent caloric intake, poor medication adherence, poor glucose control, alcohol use, and dehydration.

Clinical manifestations include nausea, vomiting, abdominal pain, weakness, polydipsia, polyuria, dehydration, weight loss, polyphagia, fruity odor of breath, dyspnea, tachypnea, Kussmaul breathing, hypotension, tachycardia, and altered mental status. Laboratory findings in DKA include hyperglycemia, anion gap metabolic acidosis, and ketonemia/ketonuria.