DKA presentation by Khlood Bashir

1. DKA
Khlood bashir
R2

2. What Is Diabetic Ketoacidosis (DKA)?
• Diabetic ketoacidosis (DKA) results
from dehydration during a state of relative insulin
deficiency, associated with high blood sugars and
ketones in urine.
• Diabetic ketoacidosis usually occurs in people with
type 1 (juvenile) diabetes mellitus (T1DM), but
diabetic ketoacidosis can develop in any person
with diabetes.
• Since type 1 diabetes typically starts before age 25
years, diabetic ketoacidosis is most common in this
age group, but it may occur at any age. Males and
females are equally affected.

3. What Are Diabetic Ketoacidosis Causes?
• Diabetic ketoacidosis occurs when a person with diabetes becomes
dehydrated. As the body produces a stress response, hormones begin to
break down muscle, fat, and liver cells into glucose and fatty acid for use
as fuel. These hormones include glucagon growth hormone, and
adrenaline. These fatty acids are converted to ketones by a process called
oxidation. The body consumes its own muscle, fat, and liver cells for fuel.
• In diabetic ketoacidosis, the body shifts from its normal fed metabolism
(using carbohydrates for fuel) to a fasting state (using fat for fuel). The
resulting increase in blood sugar occurs, because insulin is unavailable to
transport sugar into cells for future use.
• As blood sugar levels rise, the kidneys cannot retain the extra sugar, which
is dumped into the urine, thereby increasing urination and
causing dehydration . Commonly, about 10% of total body fluids are lost as
the patient slips into diabetic ketoacidosis. Significant loss of potassium
and other salts in the excessive urination is also common.

6. The most common causes of DKA :
• infection such as diarrhea , vomiting , and/or
high fever
• missed or inadequate insulin, and
• newly diagnosed or previously unknown
diabetes.
• Various other causes may include a heart
attack, stroke, trauma, stress, alcohol abuse, drug
abuse, and surgery. A low percentage of cases
have no identifiable cause.

7. What Are Symptoms and Signs of Diabetic Ketoacidosis?
• A person developing diabetic ketoacidosis may have one or more of these
symptoms:
• excessive thirst or drinking lots of fluid,
• Polyuria , polydipsia
• Dehydration
• general weakness,
• vomiting,
• loss of appetite,
• confusion,
• Abdominal pain
• shortness of breath,
• a generally ill appearance,
• increased heart rate,
• Hypotension
• increased rate of breathing ( kussmaul respiration )
• Acetone –smelling breath (pear drop smell )

8. Diagnostic criteria of DKA :
• Blood glucose >13.8 mmol/l (11 )
• PH <7.30
• Bicarbonate < 18 mmol/l (<15 mmol/l )
• Ketonemia ( ++ketone on dipstick) or >3
mmol/l ketones
. Anion gap >10

10. How to Treat Diabetic Ketoacidosis
• Fluid replacement : most pt. deplete around 5-8
liters . Isotonic saline is used initially .
• Insulin : IV continous ( .1 unit /kg /hour ) once blood
glucose is <15 mmo/l an infusion of 5% dextrose
should be started .
• Correction of hypokalemia .

12. Complications of Diabetic Ketoacidosis
• Gastric stasis
• Thromboembolism
• Arrhythmias secondary to hyperkalemia / iatrogenic
hypokalemia .
• Iatrogenic due to incorrect fluis therapy : cerebral
edema . Hypokalemia , hypoglycemia.
• ARDS
• AKI