endocrine and metabolic disorders
Diabetic Ketoacidosis (DKA)
Introduction
Diabetic ketoacidosis (DKA) is an acute metabolic complication of diabetes characterized by hyperglycemia, hyperketonemia, and metabolic acidosis. Hyperglycemia causes an osmotic diuresis with significant fluid and electrolyte loss. DKA occurs mostly in type 1 diabetes mellitus. It causes nausea, vomiting, and abdominal pain and can progress to cerebral edema, coma, and death. DKA is diagnosed by detection of hyperketonemia and anion gap metabolic acidosis in the presence of hyperglycemia. Treatment involves volume expansion,insulinreplacement, and prevention of hypokalemia. (See also Diabetes Mellitus (DM) and Diabetic ketoacidosis (DKA) occurs in patients with type 1 diabetes mellitus and is less common in those with type 2 diabetes. It develops wheninsulinlevels are insufficient to meet the body’s basic metabolic requirements. DKA is the first manifestation of type 1 diabetes in a minority of patients.Insulindeficiency can be absolute (eg, during lapses in the administration of exogenousinsulin) or relative (eg, when usualinsulindoses do not meet metabolic needs during physiologic stress). Commonphysiologic stressesthat can trigger DKA include Acute infection (eg, Overview of Pneumonia , Acute Myocardial Infarction (MI) None Overview of Stroke None Overview of Pancreatitis None Pregnancy Trauma Missedinsulindoses Somemedicationsimplicated in causing DKA include Corticosteroids Thiazide diuretics Sympathomimetics Sodium-glucose co-transporter 2 (SGLT-2) inhibitors DKA is less common in type 2 diabetes mellitus, but it may occur in situations of unusual physiologic stress. Ketosis-prone type 2 diabetes (also referred to as Flatbush diabetes) is a variant of type 2 diabetes, which sometimes occurs in patients with obesity, often those with African (including African American or Afro-Caribbean) ancestry. Patients with ketosis-prone diabetes can have significant impairment of beta-cell function with hyperglycemia, and are therefore more likely to develop DKA when significant hyperglycemia occurs. SGLT-2 inhibitors have been implicated in causing DKA in both type 1 and type 2 diabetes. In pregnant patients and in patients taking SGLT2 inhibitors, DKA may occur at lower or even normal blood glucose levels. Euglycemic DKA can also occur with alcohol overuse or cirrhosis. 