Diabetic ketoacidosis is a life-threatening complication that occurs predominantly in patients with type 1 diabetes due to a lack of insulin. The body switches to burning fatty acids which produces acidic ketone bodies, causing symptoms like weakness, shortness of breath, fruity breath, confusion and abdominal pain. Diagnosis is based on high plasma glucose, low pH and bicarbonate levels, high anion gap, and strong urine and serum ketones. Treatment involves gradual fluid replacement, electrolyte correction, low-dose insulin therapy to gradually lower blood glucose levels, and treating any precipitating causes.

2. Introduction
•Definition
•Pathophysiology
•Symptoms
•Diagnostic criteria
•Management
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3. Definition
• Potentially life-threatening complication in patients with diabetes mellitus.
• It happens predominantly in those with type 1 diabetes as a result from a shortage of insulin.
• The body switches to burning fatty acids and producing acidic ketone bodies that cause most of
the symptoms and complications.
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4. Pathophysiology
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5. Symptoms
•Weakness or fatigue
•Shortness of breath
•Fruity-scented breath
•Confusion
•Excessive thirst
•Frequent urination
•Nausea and vomiting
•Abdominal pain
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6. Diagnostic criteria
•PLASMA GLUCOSE
• >250 mg/dl (>13.9 mmol/L)
•ARTERIAL PH
• 7.25 to 7.3 in mild DKA
• 7.00 to <7.24 in moderate DKA
• <7.00 in severe DKA
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7. Diagnostic criteria
•SERUM BICARBONATE
•15 to 18 meq/L (15 to 18 mmol/L) in mild DKA
•10 to 15 meq/L (10 to 15 mmol/L) in moderate DKA
•<10 meq/L (<10 mmol/L) in severe DKA
•URINE AND SERUM KETONES
•Strong positive
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8. Diagnostic criteria
•ANION GAP
•>10 meq/L (>10 mmol/L) in mild DKA
•>12 meq/L (>12 mmol/L) in moderate and severe DKA
•MENTAL STATUS
•Alert in mild DKA
•Alert/drowsy in moderate DKA
•Coma in severe DKA
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9. Management
•THE MAIN GOALS OF TREATMENT ARE:
•Restoration of volume deficits
•Resolution of hyperglycemia and ketosis/acidosis
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10. Management
•THE MAIN GOALS OF TREATMENT ARE:
•Correction of electrolyte abnormalities:
• (K+ level should be >3.3 mmol/L before initiation of
insulin therapy)
•Treatment of the precipitating events and
prevention of complications.
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11. Management
•THERAPY INCLUDES
•Gradual fluid replacement with:
•N.S .9%
•D5W (practice based information)
•Correction of electrolyte imbalance
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12. Management
•THERAPY INCLUDES
•Insulin therapy:
•Iv bolus . 0.3 units/kg, followed by 0.2 units/kg 1 hr later,
followed by 0.2 units/kg every 2 hours until blood glucose
becomes >250 mg/dL (CHF/MI/ESRF/Pregnancy)
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13. Management
•THERAPY INCLUDES
•Insulin therapy:
•Iv infusion of 0.14 /Kg/hr (10 units /hr in a 70 kg pt) is given.
•After exclusion of hypokalemia (potassium <3.3 mEq/L), a
continuous infusion of regular insulin at a dose of 0.1 units/kg
per hour is recommended.
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14. Management
•THERAPY INCLUDES
•Insulin therapy:
•This low-dose insulin therapy decreases plasma glucose
concentration at a rate (50 to 75 mg/dL/hour).
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15. Management
•THERAPY INCLUDES
•Other therapies indicated:
•Bicarbonate therapy stills controversial but starts when PH lower than
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•Phosphate correction may be indicated for patients with cardiac
dysfunction with careful monitoring
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