DIABETES MELLITUS-KETOACIDOSIS

SUMMARY

1. Diabetic ketoacidosis (DKA) is sometimes the initial presentation of T1DM, but it can also occur in T2DM. Diagnosed by high anion gap metabolic acidosis & hyperglycemia.

2. It is caused by a state of complete or partial insulin deficiency leading to massive lipolysis.

3. Lipolysis causes a release of free fatty acids and the ketone bodies-betahydroxybutyrate, and acetoacetate.

4. These products cause volume depletion from massive osmotic diuresis and high anion gap acidosis.

5. Symptoms include nausea, vomiting, abdominal pain, polyuria, and lethargy. Precipitants include infections.

6. Delirium, fruity breath and a Kussmaul respiratory pattern suggest ketoacidosis.

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].