Hyperglycemic crises resident survival guide

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Definition

Diabetic ketoacidosis is a life threatening complication of untreated or inadequately treated Diabetes Mellitus, usually Type 1 but sometimes also seen in Type 2. It is a metabolic abnormality with hypoglycemia, metabolic acidosis and ketonuria/ketonemia. It is seen when there is lack of insulin in body, so that instead of sugars, fats are burned as fuel.

Causes

It sometimes occurs as an initial presentation in undiagnosed cases of type 1 DM, however it can also occur in people with type 2 DM. In both the types it may be precipitated by one or more of the following causes.

• Intercurrent illnesses - such as infections, is the most common risk factor precipitating DKA. Urinary tract infection's and Pneumonia being the 2 most common.

• Inadequate dosage or complete lack of insulin, such as in non-compliant cases and those with newly diagnosed type 1 DM.

• Myocardial infarction.

• Pregnancy.

• Stress such as that caused from surgery, infections etc which leads to a release of stress hormones , which are counter-regulatory to insulin.

• Dehydration.

• Medications such as corticosteroid, pentamidine, clozapine.

Management

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References

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