DKA

Diabetic ketoacidosis (DKA) is an acute, life-threatening complication of diabetes mellitus characterized by hyperglycemia, ketosis, and metabolic acidosis with dehydration. It most commonly affects individuals with type 1 diabetes but can occur in type 2 during stress or with new-onset disease.

DKA results from insulin deficiency with excess counterregulatory hormones, leading to impaired glucose uptake, increased lipolysis, ketogenesis, and anion gap acidosis. Hyperglycemia causes osmotic diuresis and dehydration. Electrolyte disturbances include total body potassium depletion despite normal or elevated serum potassium, hyponatremia from hyperglycemia, and possible shifts in phosphate and magnesium.

Clinically, patients present with polyuria, polydipsia, weight loss, nausea, vomiting, abdominal pain, tachycardia, hypotension, tachypnea or Kussmaul respiration, dehydration, and sometimes altered mental status. Diagnosis: glucose typically >250 mg/dL, bicarbonate <18 mEq/L, positive ketones, and an elevated anion gap.

Management involves rapid fluid resuscitation with isotonic saline, followed by insulin therapy after initial fluid bolus and potassium is monitored and corrected. Potassium replacement is essential; initial potassium may be high-normal, but total body potassium is depleted. Bicarbonate is considered only if pH < 6.9. Treat precipitating factors and monitor closely.

Prognosis improves with timely treatment. Mortality is generally low in developed settings but higher with delayed care, older age, or severe illness. Prevention focuses on adherence to insulin therapy, education, and early recognition during illness.