Diabetic Ketoacidosis (DKA): Clinical Features, Management & Treatment | Medical Learner

Diabetic ketoacidosis (DKA) is a life-threatening metabolic emergency that may occur in previously undiagnosed diabetes or due to acute stress like infection, or inadequate insulin therapy in known diabetics.

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Clinical Features of DKA

• Increased fat metabolism leading to fatty acid breakdown and ketone production.
• Osmotic diuresis causing massive fluid loss (up to 6–10 liters).
• Loss of electrolytes:
  • Sodium: 400–800 mmol
  • Potassium: 250–800 mmol
  • Magnesium loss
• Symptoms due to:
  • Hypovolaemia
  • Metabolic acidosis
  • Electrolyte imbalance
• Polyuria and dehydration
• Hyperventilation (Kussmaul breathing)
• Coma may not always be present but condition is life-threatening
• Plasma amylase may rise (>1000 U/L) without pancreatitis

Monitoring in DKA

Close monitoring is essential, especially in unstable patients:

• Urine output
• Blood gases (ABG)
• Plasma electrolytes
• Cardiac and circulatory status

Fluid and Electrolyte Management

1. Fluid replacement should be individualized. Rapid infusion (3–4L in first 3–4 hours) may increase risk of cerebral edema.
2. Use colloids initially in hypotension and hypoperfusion.
3. Administer 0.9% normal saline at 100–200 mL/hour until fluid deficit is corrected.
4. 0.45% saline may be used in non-shocked patients if sodium rises rapidly.
5. Add 5% dextrose (100–200 mL/hour) after sodium correction.
6. Potassium Management:
   • Monitor frequently
   • Acidosis → hyperkalemia
   • Insulin therapy → hypokalemia
   • Infusion: 10–40 mmol/hour KCl if required
7. Magnesium replacement: 3–5 mmol/hour as needed.

Management of Hyperglycemia

• Reduce glucose at 2–4 mmol/hour
• Insulin infusion: 1–5 units/hour IV
• Monitor blood glucose hourly
• Continue insulin until:
  • Ketonuria resolves
  • Base deficit normalizes

Other Important Management Steps

1. Identify and treat underlying cause (infection, MI, stroke)
2. Use antibiotics only if infection is confirmed/suspected
3. Do not ignore abdominal pain
4. Insert nasogastric tube if gastric emptying is delayed
5. Avoid bicarbonate therapy even in severe acidosis (pH < 7.0) as it may:
   • Increase intracellular acidosis
   • Depress respiration
   • Cause CSF alkalosis
   • Lead to sodium overload
6. Give LMWH (5000 units SC) in immobilized patients to prevent thrombosis

📚 Suggested for You

• Metabolic Acidosis: Complete Guide
• Metabolic Alkalosis Explained

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