Introduction

• Diabetic ketoacidosis (DKA) is a life-threatening metabolic crisis, characterized by hyperglycemia, metabolic acidosis and dehydration.
• Patients may decompensate quickly and prompt intervention is needed.
• Cause:
  • Undiagnosed insulin-dependent diabetes mellitus Diabetes mellitus.
  • Inappropriately low insulin dosages Insulin in treated animals.
  • Impaired insulin action and/or resistance caused by concurrent illness or drugs.

Pathogenesis

Etiology

• Relative or absolute insulin deficiency. Excessive lipolysis  →  production of ketone bodies in liver.
• Excessive ketosis results in metabolic acidosis Acid base imbalance.

Predisposing factors

General

• Concurrent disorders reported in the majority of patients, and may contribute to the development of DKA or overall patient morbidity:
  • Hepatic lipidosis Liver: lipidosis.
  • Cholangiohepatitis Liver: cholangitis.
  • Pancreatitis Pancreatitis.
  • Chronic renal failure Kidney: chronic kidney disease.
  • Infection, eg urinary tract infection Cystitis: bacterial.
  • Neoplasia.

• Diabetogenic drug administration, eg megestrol acetate Megestrol acetate.
• Inadequate insulin therapy Diabetes: management regimens.

Pathophysiology

• See pathophysiology of DKA Ketoacidosis pathophysiology for more detail.
• Lipolysis: non-esterified fatty acids released from adipose tissue  →  converted to ketone bodies by the liver  →  ketosis and acidosis.
• Impaired utilization of ketone bodies by peripheral tissues.
• Excess of diabetogenic hormones, fasting and dehydration  →  increased gluconeogenesis and ketogenesis.
• Increased production and decreased utilization of ketone bodies  →  accumulation of ketones in the blood  →  development of metabolic acidosis.

Timecourse

• Diabetic ketoacidosis: develops within a few days of absolute insulin deficiency.

Diagnosis

Treatment

Outcomes