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Diabetic ketoacidosis in adults

2015; Linguagem: Inglês

10.1136/bmj.h5660

1756-1833

Shivani Misra, Nick Oliver,

Pancreatic function and diabetes

What is DKA?Diabetic ketoacidosis (DKA) is an extreme metabolic state caused by insulin deficiency.The breakdown of fatty acids (lipolysis) produces ketone bodies (ketogenesis), which are acidic.Acidosis occurs when ketone levels exceed the body's buffering capacity (figure⇓). 1 2 How common is DKA?Data from the UK National Diabetes audit shows a crude one year incidence of 3.6% among people with type 1 diabetes. 3In the UK nearly 4% of people with type 1 diabetes experience DKA each year, 3 the number of DKA episodes per 100 patient years is 4.8, 4 about 6% of cases of DKA occur in adults newly presenting with type 1 diabetes, 5 and about 8% of episodes occur in hospital patients who did not primarily present with DKA. 6 How does DKA present?DKA usually develops quickly, within 24 hours.Typically, patients develop polyuria and polydipsia along with vomiting, dehydration, and, if severe, an altered mental state, including coma (box 1).Signs of the underlying cause may also be present-for example, infection. 7Abdominal pain is a common feature of DKA and may be part of the acute episode or, less often, represent an underlying cause.DKA should be considered in any unwell patient with diabetes (type 1 or type 2). How is DKA diagnosed?DKA is usually diagnosed in the presence of hyperglycaemia, acidosis, and ketosis.However, hyperglycaemia may not be present (euglycaemic ketoacidosis), and low levels of blood ketones (<3 mmol/L) may not always exclude a diagnosis.Clinical judgment therefore remains crucial.Guidelines differ on the exact biochemical thresholds for diagnosis (table 1⇓).