(A&E)

Overview

• Acute metabolic complication of diabetes that is potentially fatal and requires prompt medical attention
• More common in patients with type 1 diabetes → no insulin to suppress lipolysis → ketone formation → acidosis
• DKA may be the initial presentation in someone with undiagnosed T1DM
• Risk Factors → infection (most common precipitating factor), inadequate insulin therapy (non-compliance), undiagnosed T1DM, MI
  • Infection/illness → increased cortisol (antagonist of insulin) → bodies insulin requirements increase ⇒ hence type 1 diabetics should make sure they continue taking insulin when they are unwell to prevent DKA
  • ‘Sick Day Rules’ ⇒ continue normal insulin dose, check blood glucose more regularly, aim to drink 3L of fluid over 24hrs, self-monitor ketones regularly through day.

Making Diagnosis

Clinical Features:

• Features of Diabetes → increased thirst (polydipsia), polyuria, weight loss, excessive tiredness
• Nausea & Vomiting
• Severe Abdominal Pain
• Dehydration → dry mucous membranes, decreased skin turgor, slow CRT, tachycardic, hypotensive
• Hyperventilation → kussmmaul breathing (decrease in pH stimulates respiratory centre to try and correct acidosis by blowing off CO2)
• Reduced Consciousness
• Fruity Breath
• Rapid Onset (<24 hrs)