This document summarizes information on diabetic ketoacidosis (DKA). It discusses that DKA occurs when there is a lack of insulin and excess of counterregulatory hormones. Common precipitating factors include infections. Symptoms include polyuria, polydipsia, weight loss, vomiting, and altered mental status. Diagnosis involves finding hyperglycemia, ketonemia, and acidosis on labs and tests. Treatment focuses on hydration, insulin administration, electrolyte replacement, and bicarbonate in some cases. Prognosis is generally good if treated properly but elderly patients, those in a coma, or with severe hypotension have a higher risk of death. Ongoing research continues on optimizing treatment

1. CRISIS
HIPERGLICEMICAS
FRANCO MIO PALACIOS
MEDICO ENDOCRINOLOGO

2. Cada 10 segundos una persona
muere por la diabetes
Cada 10 segundos dos personas
desarrollan diabetes
Cada año 7 millones de personas
desarrollan diabetes

3. MAP 2.1
Prevalence (%) estimates of diabetes (20-79 years), 2010

5. PUBLICACIONES CETOACIDOSIS DIABETICA

6. PUBLICACIONES CETOACIDOSIS DIABETICA

10. Reflexión
 Aunque la
cetoacidosis diabética
se presenta con
mayor frecuencia en
diabetes tipo 1, esta
también se presenta
en algunos pacientes
con diabetes tipo 2.
ABBAS E. KITABCHI, PH.D., M.D
AUTOR DE 38 PUBLICACIONES

11. Laine C, Turner B, Williams S. In the clinic diabetic ketoacidosis. Annals of
Internal Medicine 2010; ITLC1: 1-16.

12. MORTALIDAD
Cetoacidosis
diabética < 5%.
Estado
hiperosmolar 15%.
Kitabchi A, Umpierrez G, Miles J, Fisher J. Hyperglycemic crises in adult patients
with diabetes. DIABETES CARE, 2009; 32(7): 1335-43.

13. ALTO RIESGO DE MORIR
 ANCIANOS
 ESTADO DE COMA
 HIPOTENSION
SEVERA
Kitabchi A, Umpierrez G, Miles J, Fisher J. Hyperglycemic crises in adult patients
with diabetes. DIABETES CARE, 2009; 32(7): 1335-43.

14. PATOGENESIS COMUN
DEFICIT DE INSULINA
EXCESO DE HOMONAS
CONTRARREGULADORAS
Kitabchi A, Umpierrez G, Miles J, Fisher J. Hyperglycemic crises in adult patients
with diabetes. DIABETES CARE, 2009; 32(7): 1335-43.

15. Chiasson JL, Aris-Jilwan N, Bélanger R, Bertrand S, Beauregard H, Ékoé JM,
Fournier H, Havrankova J. Diagnosis and treatment of diabetic ketoacidosis and the
hyperglycemic hyperosmolar state. CMAJ 2003;168(7):859-66.

16. PATOGENESIS EN CADENA

17. Kitabchi A, Umpierrez G, Miles J, Fisher J. Hyperglycemic crises in adult patients
with diabetes. DIABETES CARE, 2009; 32(7): 1335-43.

18. Acetoacetyl
CoA
β-hydroxy-β-
methylglutaryl CoA
acetoacetateacetoacetate
β-hydroxybutyrateβ-hydroxybutyrate acetoneacetone
acetyl CoA
acetyl CoA CoA
+ H2O
NADH + H+
NAD+ H+
CO2
2 CH3 -C S-CoA~
O
||
CoA
acetyl CoA
(2C)
(4C)
(4C)
(4C)
(6C)
(3C)
(HMG CoA)

19. Kitabchi A, Umpierrez G, Miles J, Fisher J. Hyperglycemic crises in adult patients
with diabetes. DIABETES CARE, 2009; 32(7): 1335-43.

20. Laine C, Turner B, Williams S. In the clinic diabetic ketoacidosis. Annals of
Internal Medicine 2010; ITLC1: 1-16.

21. Factor precipitante principal
Infecciones
Kitabchi A, Umpierrez G, Miles J, Fisher J. Hyperglycemic crises in adult patients
with diabetes. DIABETES CARE, 2009; 32(7): 1335-43.

22. Otros precipitantes
 Isquemia cerebral
 Abuso alcohol
 Pancreatitis
 Infarto de miocardio
 Trauma
 Corticoides
 Olanzapina
 Hipertiroidismo
 Debut
 Suspensión terapia
Kitabchi A, Umpierrez G, Miles J, Fisher J. Hyperglycemic crises in adult patients
with diabetes. DIABETES CARE, 2009; 32(7): 1335-43.

23. Laine C, Turner B, Williams S. In the clinic diabetic ketoacidosis. Annals of
Internal Medicine 2010; ITLC1: 1-16.

24. Historia clínica completa
 Poliuria
 Polidipsia
 Polifagia
 Pérdida de peso
 Vómitos
 Dolor abdominal
 Deshidratación
 Alteración sensorio
 Coma
Kitabchi A, Umpierrez G, Miles J, Fisher J. Hyperglycemic crises in adult patients
with diabetes. DIABETES CARE, 2009; 32(7): 1335-43.

25. Historia clínica completa
Piel fría
Respiración
Kussmaul
Taquicardia
Hipotensión
Alteración
Mental
Shock
Coma
Kitabchi A, Umpierrez G, Miles J, Fisher J. Hyperglycemic crises in adult patients
with diabetes. DIABETES CARE, 2009; 32(7): 1335-43.

26. Clínica de Cetoacidosis
Sintonas Signos Laboratorio
Poli-oliguria Deshidratc Hiperglicemia
Anorexia Hipotension Cetonemia
Vómitos Taquicardia Acidosis
Cólicos Hipotermia Natremia.
Calambres Polipnea
Leucocitosis
Disnea Coma Amilasemia
Kitabchi A, Umpierrez G, Miles J, Fisher J. Hyperglycemic crises in adult patients
with diabetes. DIABETES CARE, 2009; 32(7): 1335-43.

27. Compromiso de la conciencia
dependiente de la osmolalidad
300
310
320
330
340
350
360
Alerta Sueño Estupor Coma
Kitabchi AE, Wall B. Diabetic ketoacidosis. Med Clin North Am 1995;79(1):10–37.

28. Kitabchi A, Umpierrez G, Miles J, Fisher J. Hyperglycemic crises in adult patients
with diabetes. DIABETES CARE, 2009; 32(7): 1335-43.

29. Exámenes de Urgencia
 Glucosa
 Urea
 Creatinina
 Electrolitos
 Examen de orina
 Gases arteriales
 Hemograma
Kitabchi A, Umpierrez G, Miles J, Fisher J. Hyperglycemic crises in adult patients
with diabetes. DIABETES CARE, 2009; 32(7): 1335-43.

30. Exámenes Complementarios
 Cetonas
 Osmolalidad
 Electrocardiograma
 Cultivos
 Hba1c
 Radiografía torax
 Amilasa
 Lípidos
Kitabchi A, Umpierrez G, Miles J, Fisher J. Hyperglycemic crises in adult patients
with diabetes. DIABETES CARE, 2009; 32(7): 1335-43.

31. Laine C, Turner B, Williams S. In the clinic diabetic ketoacidosis. Annals of
Internal Medicine 2010; ITLC1: 1-16.

32. Laine C, Turner B, Williams S. In the clinic diabetic ketoacidosis. Annals of
Internal Medicine 2010; ITLC1: 1-16.

33. Kitabchi A, Umpierrez G, Miles J, Fisher J. Hyperglycemic crises in adult patients
with diabetes. DIABETES CARE, 2009; 32(7): 1335-43.

34. Diagnóstico diferencial
 Cetosis de ayuno
 Cetoacidosis alcohólica
 Hipoglicemia
 Acidosis láctica
 Salicilatos
 Metanol
 Etilenglicol
 Insuficiencia renal
 Acidosis hiperclorémica
 Paraldehido
Kitabchi A, Umpierrez G, Miles J, Fisher J. Hyperglycemic crises in adult patients
with diabetes. DIABETES CARE, 2009; 32(7): 1335-43.

35. Laine C, Turner B, Williams S. In the clinic diabetic ketoacidosis. Annals of
Internal Medicine 2010; ITLC1: 1-16.

36. CETOACIDOSIS DIABETICA Y ESTADO
HIPERGLUCEMICO HIPEROSMOLAR
DKA
ACIDOSISHIPER-
GLICEMIA
CETOSIS
OTROS ESTADOS
HIPERGLUCEMICOS:
1. DIABETES MELLITUS
2. COMA HIPEROSMOLOR NO
CETOSICO
3. TOLERANCIA A LA
GLUCOSA DETERIORADA
4. HIPERGLUCEMIA DE
STRESS
OTROS ESTADOS
CETOSICOS:
A. HIPOGLUCEMIA
CETOSICA
B. CETOSIS ALCOHOLICA
C. CETOSIS DE INANICION
OTROS ESTADOS DE
ACIDOSIS METABOLICA:
I. ACIDOSIS LACTICA
II. ACIDOSIS HIPERCLOREMICA
III. SALICISMO
IV. ACIDOSIS UREMICA
V. ACIDOSIS INDUCIDA POR DROGAS

37. Tratamiento
 Hidratación
 Insulina
 Potasio
 Bicarbonato
 Fosfato
Kitabchi A, Umpierrez G, Miles J, Fisher J. Hyperglycemic crises in adult patients
with diabetes. DIABETES CARE, 2009; 32(7): 1335-43.

41. Kitabchi A, Umpierrez G, Miles J, Fisher J. Hyperglycemic crises in adult patients
with diabetes. DIABETES CARE, 2009; 32(7): 1335-43.

42. Wolfsdorf J, Craig
ME, Daneman D,
Dunger D, Edge
J, Lee W,
Rosenbloom A,
Sperling M, and
Hanas R. ISPAD
Clinical Practice
Consensus
Guidelines 2009
Compendium.
Diabetic
ketoacidosis in
children and
adolescents with
diabetes.
Pediatric Diabetes
2009: 10(Suppl.
12): 118–33

43. Wolfsdorf J, Craig
ME, Daneman D,
Dunger D, Edge
J, Lee W,
Rosenbloom A,
Sperling M, and
Hanas R. ISPAD
Clinical Practice
Consensus
Guidelines 2009
Compendium.
Diabetic
ketoacidosis in
children and
adolescents with
diabetes.
Pediatric Diabetes
2009: 10(Suppl.
12): 118–33

44. Kitabchi A, Umpierrez G, Miles J, Fisher J. Hyperglycemic crises in adult patients
with diabetes. DIABETES CARE, 2009; 32(7): 1335-43.

46. Laine C, Turner B, Williams S. In the clinic diabetic ketoacidosis. Annals of
Internal Medicine 2010; ITLC1: 1-16.

48. Laine C, Turner B, Williams
S. In the clinic diabetic
ketoacidosis. Annals of
Internal Medicine 2010;
ITLC1: 1-16.

51. Dunger DB, Sperling MA, Acerini CL, Bohn DJ, Daneman D, Danne TP, Glaser NS,
Hanas R, Hintz RL, Levitsky LL, Savage MO, Tasker RC, Wolfsdorf JI.
ESPE/LWPES consensus statement on diabetic ketoacidosis in children and
adolescents. Arch Dis Child 2004;89:188–94.

52. Dunger DB, Sperling MA, Acerini CL, Bohn DJ, Daneman D, Danne TP, Glaser NS,
Hanas R, Hintz RL, Levitsky LL, Savage MO, Tasker RC, Wolfsdorf JI.
ESPE/LWPES consensus statement on diabetic ketoacidosis in children and
adolescents. Arch Dis Child 2004;89:188–94.

53. Dunger DB, Sperling MA,
Acerini CL, Bohn DJ,
Daneman D, Danne TP,
Glaser NS, Hanas R, Hintz
RL, Levitsky LL, Savage MO,
Tasker RC, Wolfsdorf JI.
ESPE/LWPES consensus
statement on diabetic
ketoacidosis in children and
adolescents. Arch Dis Child
2004;89:188–94.

54. Dunger DB, Sperling MA,
Acerini CL, Bohn DJ,
Daneman D, Danne TP,
Glaser NS, Hanas R, Hintz
RL, Levitsky LL, Savage MO,
Tasker RC, Wolfsdorf JI.
ESPE/LWPES consensus
statement on diabetic
ketoacidosis in children and
adolescents. Arch Dis Child
2004;89:188–94.

55. FUTURAS INVESTIGACIONES
1) USO DE BICARBONATO (PH<6.9)
2) DOSIS DE INSULINA BOLO O INFUSION
3) MECANISMO DE AUSENCIA DE CETOSIS
EN ESTADO HIPEROSMOLAR
4) MECANISMO DE PRODUCCION ELEVADA
DE CITOQUINAS
5) USO DE INSULINA SUBCUTANEA COMO
TRATAMIENTO INICIAL DKA
Kitabchi AE, Umpierrez GE, Fisher JN, Murphy MB, Stentz FB. Thirty Years of
Personal Experience in Hyperglycemic Crises: Diabetic Ketoacidosis and
Hyperglycemic Hyperosmolar State. J Clin Endocrinol Metab2008; 93: 1541–52.