Introduction

•Definition

•Pathophysiology

•Symptoms

•Diagnostic criteria

•Management

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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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Pathophysiology

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Symptoms

•Weakness or fatigue

•Shortness of breath

•Fruity-scented breath

•Confusion

•Excessive thirst

•Frequent urination

•Nausea and vomiting

•Abdominal pain

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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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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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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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Management

•THE MAIN GOALS OF TREATMENT ARE:

•Restoration of volume deficits•Resolution of hyperglycemia and ketosis/acidosis

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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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Management

•THERAPY INCLUDES

•Gradual fluid replacement with:•N.S .9% •D5W (practice based information)

•Correction of electrolyte imbalance

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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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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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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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Management

•THERAPY INCLUDES

•Other therapies indicated:•Bicarbonate therapy stills controversial but starts when PH lower than

7•Phosphate correction may be indicated for patients with cardiac

dysfunction with careful monitoring

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