Medical Emergency: Diabetic Ketoacidosis (DKA)

Introduction

• Diabetic ketoacidosis (DKA) is a life-threatening emergency
• Requires prompt diagnosis and treatment
• Characterised by hyperglycaemia, metabolic acidosis and ketonaemia
• DKA occurs mostly in type 1 diabetes

Causes/Precipitating Factors

• Lack of insulin e.g. non-compliance, undiagnosed diabetes
• Drugs e.g. some antipsychotics, corticosteroids, thiazide diuretics, sodium-glucose co-transporter-2 (SGLT2) inhibitors
• Infection e.g. urinary tract infection, pneumonia
• Myocardial infarction
• Stroke
• Illicit drug use e.g. cocaine
• Alcohol

Symptoms and Signs of DKA

• Lethargy
• Abdominal pain
• Dehydration
• Polydipsia
• Polyuria
• Ketones on breath (smell of pear drops)
• Kussmaul respiration (deep and rapid breathing)
• Tachycardia
• Vomiting
• Weight loss

Note: clinical presentation varies with the severity of DKA and the presence of comorbid condition(s)

Diagnosis of DKA

• Ketonaemia ≥ 3.0mmol/L or significant ketonuria (more than 2+ on standard urine sticks)
• Blood glucose > 11.0mmol/L or known diabetes mellitis
• Bicarbonate (HCO3^–) < 15.0mmol/L and/or venous pH < 7.3

Source: Joint British Diabetes Societies Inpatient Care Group. The management of diabetic ketoacidosis in adults. 2nd ed. London: Joint British Diabetes Societies Inpatient Care Group for NHS Diabetes, 2013.

Management

• Hospital protocol/guideline followed
• Involves: Insulin administration and replacement of fluid and electrolytes

Complications of DKA

• Hypokalaemia and hyperkalaemia
• Hypoglycaemia
• Cerebral oedema
• Pulmonary oedema

Prevention of DKA

• Patient education on: recognising signs and symptoms of DKA, possible risk factors for DKA, sick day rules, how to monitor blood glucose and ketone levels, the importance of medication compliance

Further DKA Clinical Resources

The management of diabetic ketoacidosis in adults

This comprehensive guideline from the Joint British Diabetes Societies (JBDS) on the management of DKA provides a detailed DKA pathway of care that is clear and easy to follow.

The guideline also addresses best practice for DKA and the complications of DKA.

To read the full guideline, click here.

MHRA Update: Risk of DKA with SGLT2 inhibitors

In this drug safety update from MHRA, healthcare professionals are warned about the risk of DKA with SGLT2 inhibitors (canagliflozin, dapagliflozin, or empagliflozin). It also gives guidance to healthcare professionals who are treating patients taking SGTLT2 inhibitors

To read the full update, click here.