Diabetic
Ketoacidosis
Dr shumaila
House officer
Medical unit 3
Content
Introduction .
Clinical signs Management
Pathophysiolo Diagnosis Complications
gy
Introduction
01
DKA is a serious acute complications of
Diabetes Mellitus. It carries significant
risk of death and/or morbidity especially
with delayed treatment.
02 The prognosis of DKA is worse in the
extremes of age, with a mortality
rates of 5-10%.
03
With the new advances of therapy,
DKA mortality decreases to > 2%.
Before discovery and use of Insulin
(1922) the mortality was 100%..
• Pathophysiology
In the absence of insulin Thus, insulin deficiency results in
activity the body fails to utilize hyperglycemia (from increased hepatic
glucose as fuel and uses fats glucose production and decreased
instead. This leads to ketosis. peripheral uptake) and acidosis
(primarily derived from hepatic fatty
acid oxidation into ketoacids).
The excess of ketone bodies will
Because of acidosis, K ions cause metabolic acidosis, the later
enter the circulation leading is also aggravated by Lactic
to hyperkalemia, this is acidosis caused by dehydration &
aggravated by dehydration poor tissue perfusion.
and renal failure.
Pathophysiology .
> So, depending on the duration of
DKA, serum K at diagnosis may be
high, normal or low, but the
intracellular K stores are always
depleted.
>The increasing acidosis leads to
acidotic breathing and acetone
smell in the breath and eventually
causes impaired consciousness
and coma.
Clinical signs
>Tachycardia
>Dehydration
(polyuria)
>Tachypnea
>Nausea,
>Abdominal pain that may vomiting
mimic an acute abdominal >Deep, sighing
condition (Kussmaul) respiration
>Confusion, drowsiness, >Acetone breath
progressive loss of
consciousness.
Diagnosis Ketonemia
Acidotic An altered mental and ketonuria
(Kussmaul’s) status ranging
breathing, with a from disorientation
fruity smell to coma.
(acetone). A To diagnose DKA,
the following criteria
You should Hyperglycemia: must be
suspect DKA if a of > 300 mg/dl & fulfilled :
diabetic patient glucosuria
presents with:
B Metabolic acidosis: pH < 7.25,
Abdominal
serum bicarbonate < 15 mmol/l.
pain &\or
Anion gap >10.
distension. Dehydration. Anion gap= [Na]+[K] – [Cl]+
Vomiting.
[HCO3].
Cerebral Edema
Acute tubular necrosis.
Complications
Intracranial thrombosis peripheral edema.
or infarction.
Thank you
