Diagnosis and Management of Diabetic Ketoacidosis in Adults

Hospital Physician March 2008 21 D iabetic ketoacidosis (DKA) is a serious and potentially life-threatening complication of diabetes mellitus.1,2 It represents a state of insulin deficiency with a concurrent elevation in counterregulatory hormones.2–6 The annual incidence ranges from 4.6 to 8 cases per 1000 diabetic patients, and DKA carries a mortality rate of 2% to 10%.2 DKA occurs more commonly in patients who have type 1 diabetes as compared with patients who have type 2 diabetes.5 However, recent data suggest that African American and Hispanic patients are more likely to develop DKA in the setting of type 2 diabetes than are white patients.7,8 Diagnosing DKA centers on identifying the classic triad of hyperglycemia, ketosis, and acidosis. Management focuses on treating the precipitating factors and correcting dehydration, hyperglycemia, and electrolyte abnormalities. Despite available guidelines, DKA has been shown to be inadequately managed in teaching hospitals.9,10 This article reviews the approach to accurate diagnosis and timely management of DKA.