endocrine and metabolic disorders
Diabetic Ketoacidosis (DKA)
Key Points
Diabetic ketoacidosis (DKA) is an acute metabolic complication of diabetes characterized by hyperglycemia, hyperketonemia, and metabolic acidosis. DKA can occur when acute physiologic stressors (eg, infections, myocardial infarction) trigger acidosis, moderate glucose elevation, dehydration, and severe potassium loss in patients with type 1 diabetes. Diagnose by an arterial pH<7.30, with an anion gap>12 and serum ketones in the presence of hyperglycemia. Acidosis typically corrects with IV fluid andinsulin; consider bicarbonate only if marked acidosis (pH<7) persists after 1 hour of therapy. Withholdinsulinuntil serum potassium is≥3.3 mEq/L (≥3.3 mmol/L). Acute cerebral edema is a rare (about 1%) but lethal complication, primarily in children and less often in adolescents and young adults. 