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Diabetic Ketoacidosis — Emergency Management

Severe hyperglycaemia, ketonaemia and metabolic acidosis require rapid fluid, insulin and electrolyte therapy.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Acil Servis department. Book Appointment →

What is Diabetic Ketoacidosis — Emergency Management?

DKA develops as a result of absolute or relative insulin deficiency and counter-regulatory hormone (glucagon, catecholamine, cortisol) excess.

Lipolysis and hepatic ketogenesis lead to accumulation of beta-hydroxybutyrate and acetoacetate, producing acidosis.

It is more common in type 1 diabetes; the leading triggers are infection, missed insulin doses and newly diagnosed diabetes.

Symptoms

Polyuria, polydipsia and weight loss
Nausea, vomiting and abdominal pain
Kussmaul (deep, rapid) breathing
Acetone (fruity) breath odour
Dehydration, dry mucous membranes, tachycardia
Confusion, lethargy, in severe cases coma
Hypotension and shock signs

Risk Factors

Type 1 diabetes mellitus and insulin omission
Severe infection (pneumonia, urinary tract, sepsis)
Acute myocardial infarction or stroke
Pancreatitis and severe stress
SGLT2 inhibitor use (euglycaemic DKA)
Newly diagnosed diabetes (first presentation)
Pregnancy and high-dose corticosteroid therapy

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Bring the patient to the emergency department urgently in any altered consciousness, vomiting and rapid breathing
  • Glucose >250 mg/dL with positive ketones and pH <7.30 mandates hospital admission
  • Intensive care monitoring is required for cardiac, renal failure or severe acidosis
  • Long-term endocrinology follow-up is essential after recovery

Treatment Methods

01
Aggressive intravenous saline (0.9% NaCl) resuscitation 1–1.5 L in the first hour
02
Continuous intravenous insulin infusion 0.1 U/kg/h
03
Potassium replacement (start when K <5.3 mEq/L)
04
Bicarbonate only in severe acidosis (pH <6.9)
05
Identification and treatment of the precipitating cause (antibiotic, etc.)
06
Hourly glucose, electrolyte and acid-base monitoring

Which Department to Visit?

You can visit our Acil Servis department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.