Diabetic Ketoacidosis Questions & Answers

Updated: Feb 08, 2018
  • Author: Osama Hamdy, MD, PhD; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Questions & Answers

Overview

What is diabetic ketoacidosis (DKA)?

What are the signs and symptoms of diabetic ketoacidosis (DKA)?

What are signs that diabetic ketoacidosis (DKA) is associated with intercurrent infection?

What are physical findings of diabetic ketoacidosis (DKA)?

Which lab studies are performed in diabetic ketoacidosis (DKA)?

Which imaging studies are helpful in diabetic ketoacidosis (DKA)?

What are the treatment goals for diabetic ketoacidosis (DKA)?

Which medications are used in the management of diabetic ketoacidosis (DKA)?

In which types of diabetes is diabetic ketoacidosis (DKA) likely to occur?

What causes diabetic ketoacidosis (DKA)?

What is the clinical definition of diabetic ketoacidosis (DKA)?

What is the biochemical definition of diabetic ketoacidosis (DKA)?

Are arterial and venous samples reliable in the management of diabetic ketoacidosis (DKA)?

Are mental changes typical in diabetic ketoacidosis (DKA)?

How is the metabolic state characterized in diabetic ketoacidosis (DKA)?

What are the roles of hepatic gluconeogenesis, glycogenolysis, and lipolysis in the pathogenesis of diabetic ketoacidosis (DKA)?

What is the role of acetyl coenzyme A in the pathophysiology of diabetic ketoacidosis (DKA)?

How is ketonemia reflected in diabetic ketoacidosis (DKA)?

How does diabetic ketoacidosis (DKA) affect breathing?

What symptoms are caused by ketones, ketoacids, and hydroxy acids in diabetic ketoacidosis (DKA)?

What causes potassium and sodium loss in diabetic ketoacidosis (DKA)?

What is the typical overall electrolyte loss in diabetic ketoacidosis (DKA)?

How are potentially lethal complications (hypoglycemia, hyponatremia, hypokalemia) prevented in diabetic ketoacidosis (DKA)?

What causes hyperglycemia in diabetic ketoacidosis (DKA)?

What are the secondary consequences of the primary metabolic derangements in diabetic ketoacidosis (DKA)?

What causes dehydration in diabetic ketoacidosis (DKA)?

What are the roles of dehydration and electrolyte loss in the development of diabetic ketoacidosis (DKA)?

What causes diabetic ketoacidosis (DKA)?

What causes diabetic ketoacidosis (DKA) in type 1 diabetes mellitus (DM)?

What causes diabetic ketoacidosis (DKA) in type 2 diabetes mellitus (DM)?

What causes diabetic ketoacidosis (DKA) in pregnant women?

What is the incidence of diabetic ketoacidosis (DKA)?

What is the incidence of diabetic ketoacidosis (DKA) in patients with diabetes?

What is the incidence of diabetic ketoacidosis (DKA) in developing countries?

Is the incidence of diabetic ketoacidosis (DKA) higher in specific racial or gender groups?

What age groups are most affected by diabetic ketoacidosis (DKA)?

What are the risk factors for development of diabetic ketoacidosis (DKA)?

What is the mortality rate for diabetic ketoacidosis (DKA)?

What is the general prognosis of diabetic ketoacidosis (DKA)?

How does treatment affect the mortality rate for diabetic ketoacidosis (DKA)?

What is the fetal mortality rate for diabetic ketoacidosis (DKA)?

How does hospitalization affect the mortality rate for diabetic ketoacidosis (DKA)?

What are the most common causes of mortality in diabetic ketoacidosis (DKA)?

What factors help reduce the overall mortality of diabetic ketoacidosis (DKA)?

What should be included in patient education to promote prevention of diabetic ketoacidosis (DKA)?

Presentation

Which symptoms suggest diabetic ketoacidosis (DKA)?

Does failure to comply with insulin therapy increase the risk of diabetic ketoacidosis (DKA)?

Are disorientation, confusion, or coma signs of diabetic ketoacidosis (DKA)?

What symptoms of diabetic ketoacidosis (DKA) suggest incurrent infection?

Which children are most likely to develop diabetic ketoacidosis (DKA)?

What are the physical signs of diabetic ketoacidosis (DKA)?

How does diabetic ketoacidosis (DKA) affect vital signs?

What physical findings are specific signs of diabetic ketoacidosis (DKA)?

What are symptoms of hyperglycemia in diabetic ketoacidosis (DKA)?

What are signs of acidosis in diabetic ketoacidosis (DKA)?

What are signs of dehydration in diabetic ketoacidosis (DKA)?

Is there a direct correlation between the degree of acidosis, hyperglycemia, and the disturbances in the level of consciousness?

What are the possible complications of diabetic ketoacidosis (DKA)?

DDX

Which indications would suggest a diagnosis of diabetic ketoacidosis (DKA)?

What are the differential diagnoses for Diabetic Ketoacidosis?

Workup

What levels of glucose, bicarbonate, and pH characterize diabetic ketoacidosis (DKA)?

How are mild, moderate, and severe diabetic ketoacidosis (DKA) defined?

When should lab testing for diabetic ketoacidosis (DKA) be performed?

What is the initial workup for diabetic ketoacidosis (DKA), and which tests should be repeated?

What may cause false findings in lab tests for diabetic ketoacidosis (DKA)?

What is the typical blood glucose level in diabetic ketoacidosis (DKA)?

Which urine dipstick findings suggest diabetic ketoacidosis (DKA)?

What urine dipstick findings suggest improvement of diabetic ketoacidosis (DKA) due to treatment?

How are ketones measured in diabetic ketoacidosis (DKA)?

What do Acetest and Ketostix measure in diabetic ketoacidosis (DKA?

How is ketonuria diagnosed in diabetic ketoacidosis (DKA)?

Is urine testing for ketones necessary to diagnose diabetic ketoacidosis (DKA)?

What are the JBDS guidelines for blood ketones measures in diabetic ketoacidosis (DKA)?

How are beta-hydroxybutyrate levels used to monitor response to treatment in diabetic ketoacidosis (DKA)?

What are the JBDS guidelines regarding the use of arterial blood gases (ABGs) in diabetic ketoacidosis (DKA)?

What is the role of serum potassium levels in the evaluation and treatment of diabetic ketoacidosis (DKA)?

What is the role of serum sodium levels in the evaluation and treatment of diabetic ketoacidosis (DKA)?

What are the typical serum chloride and phosphorus levels in diabetic ketoacidosis (DKA)?

What is the role of bicarbonate levels in the evaluation of diabetic ketoacidosis (DKA)?

What is the expected anion gap in diabetic ketoacidosis (DKA)?

What does a high WBC count indicate in diabetic ketoacidosis (DKA)?

What renal function findings suggest diabetic ketoacidosis (DKA)?

What is the role of plasma osmolarity in the evaluation of diabetic ketoacidosis (DKA)?

What are the roles of blood and urine cultures in the evaluation of diabetic ketoacidosis (DKA)?

Is hyperamylasemia seen in diabetic ketoacidosis (DKA)?

When is serum phosphorous testing indicated in diabetic ketoacidosis (DKA)?

When is a chest X-ray useful in the diagnosis of diabetic ketoacidosis (DKA)?

When is MRI useful in the diagnosis of diabetic ketoacidosis (DKA)?

When is CT scanning useful in the diagnosis of diabetic ketoacidosis (DKA)?

What is the role of ECG in the workup of diabetic ketoacidosis (DKA)?

When is telemetry indicated in diabetic ketoacidosis (DKA)?

Treatment

What should be monitored during the treatment of diabetic ketoacidosis (DKA)?

Why is correction of fluid and electrolyte loss important during treatment for diabetic ketoacidosis (DKA)?

When can patients with diabetic ketoacidosis (DKA) be discharged from the hospital?

When can insulin infusion be discontinued in the treatment of diabetic ketoacidosis (DKA)?

What are the JBDS guidelines for the rate of IV infusion of insulin in diabetic ketoacidosis (DKA)?

What is the insulin dose for treatment of diabetic ketoacidosis (DKA) in established diabetes?

What is the insulin dose for treatment of diabetic ketoacidosis (DKA) in newly diagnosed type 1 diabetes?

How is fluid loss treated in diabetic ketoacidosis (DKA)?

What is the recommended schedule for restoring fluids during treatment of diabetic ketoacidosis (DKA)?

What changes may be made to correction of fluid loss during diabetic ketoacidosis (DKA) after the patient becomes euvolemic?

How is severe dehydration treated in diabetic ketoacidosis (DKA)?

How is decreased blood sugar levels treated in diabetic ketoacidosis (DKA)?

When should insulin be started in diabetic ketoacidosis (DKA)?

Should insulin administration begin prior to rehydration in diabetic ketoacidosis (DKA)?

What are the ISPAD Clinical Practice Consensus Guidelines for initial fluid repletion in pediatric patients with diabetic ketoacidosis (DKA)?

What are the considerations prior to initiating insulin therapy in diabetic ketoacidosis (DKA)?

What is the initial insulin therapy dose for diabetic ketoacidosis (DKA)?

What is the optimal rate of glucose decline in diabetic ketoacidosis (DKA)?

Are insulin infusion pumps equipped with alarm systems effective in reducing the incidence of diabetic ketoacidosis (DKA)?

When is potassium chloride administered in the treatment of diabetic ketoacidosis (DKA)?

How often and for how long should serum potassium levels be monitored in the treatment of diabetic ketoacidosis (DKA)?

Should insulin therapy begin before hypokalemia is treated in diabetic ketoacidosis (DKA)?

When should potassium replacement be initiated in diabetic ketoacidosis (DKA)?

How is acidosis treated in diabetic ketoacidosis (DKA)?

How is infection treated in diabetic ketoacidosis (DKA)?

How is hypokalemia treated in diabetic ketoacidosis (DKA) treated?

Which patients are primary affected by cerebral edema during treatment of diabetic ketoacidosis (DKA)?

How is cerebral edema managed in diabetic ketoacidosis (DKA)?

Is there an effective treatment for clinical cerebral edema in diabetic ketoacidosis (DKA)?

What is the mortality rate and prevalence of neurologic sequelae in children with cerebral edema during the treatment of diabetic ketoacidosis (DKA)?

What are the diagnostic criteria for cerebral edema in diabetic ketoacidosis (DKA)?

What are the risk factors for developing cerebral edema in diabetic ketoacidosis (DKA)?

How is cardiac dysrhythmia treated in diabetic ketoacidosis (DKA)?

How is pulmonary edema treated in diabetic ketoacidosis (DKA)?

How is myocardial injury treated in diabetic ketoacidosis (DKA)?

How is diabetic retinopathy treated in diabetic ketoacidosis (DKA)?

How is hypoglycemia treated in diabetic ketoacidosis (DKA)?

Which specialists should be consulted in the treatment of diabetic ketoacidosis (DKA)?

Does frequent home monitoring of blood glucose reduce the risk of diabetic ketoacidosis (DKA)?

Medications

Which medications are used in the management of diabetic ketoacidosis (DKA)?

What is the goal of treatment in diabetic ketoacidosis (DKA)?

Should insulin dosages be adjusted in diabetic ketoacidosis (DKA) in the setting of established diabetes?

Which medications in the drug class Rapid-acting insulins are used in the treatment of Diabetic Ketoacidosis?

Which medications in the drug class Short-acting insulins are used in the treatment of Diabetic Ketoacidosis?

Which medications in the drug class Electrolyte Supplement are used in the treatment of Diabetic Ketoacidosis?

Which medications in the drug class Alkalinizing Agents are used in the treatment of Diabetic Ketoacidosis?