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Diabetic Ketoacidosis

Diabetic Ketoacidosis is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

Insulin deficiency and excess of counterregulatory hormones (catecholamines, glucagon, growth hormone, and cortisol) resulting in:
  • Dehydration (osmotic, hyperglycemic, diuresis, and decreased oral intake)
  • Acidosis (anion gap metabolic acidosis)
  • Ketone formation (unrestrained lipolysis and ketogenesis)
  • Hyperglycemia (unrestrained glycogenolysis and gluconeogenesis)
  • Electrolyte disturbances (hypokalemia, hypo/hypernatremia, hypophosphatemia)

Etiology

  • Medication noncompliance (>50%)
  • New-onset diabetes (type I or II)
  • Underlying medical illness (increased counterregulatory hormones and insulin resistance):
    • Infectious process
    • MI
    • GI bleed
    • CNS event
  • Pregnancy (relative insulin deficiency and counterregulatory hormone excess)
  • Medications (protease inhibitors and atypical antipsychotics: Olanzapine, clozapine)
  • Alcohol abuse

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Citation

Rosen, Peter, et al., editors. "Diabetic Ketoacidosis." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307314/all/Diabetic_Ketoacidosis.
Diabetic Ketoacidosis. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307314/all/Diabetic_Ketoacidosis. Accessed April 24, 2019.
Diabetic Ketoacidosis. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307314/all/Diabetic_Ketoacidosis
Diabetic Ketoacidosis [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 24]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307314/all/Diabetic_Ketoacidosis.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Diabetic Ketoacidosis ID - 307314 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307314/all/Diabetic_Ketoacidosis PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -