Diabetic Ketoacidosis

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

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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)


  • 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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