Materiały źródłowe

• #1 Adult Diabetic Ketoacidosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK560723/

  Diabetic ketoacidosis (DKA) is characterized by uncontrolled hyperglycemia, metabolic acidosis, and increased body ketone concentration. […] DKA is a state of a relative or absolute insulin deficiency that is worsened by hyperglycemia, dehydration, and acidosis. […] This activity highlights the role of the interprofessional team in evaluating and managing patients suffering from this disorder in order to achieve the best outcomes. […] Diabetic ketoacidosis (DKA) is characterized by hyperglycemia, acidosis, and ketonemia. […] Common precipitating factors for DKA are non-compliance, new-onset diabetes, and other acute medical illness. […] The most common types of infections are pneumonia and urinary tract infections. […] Commonly accepted criteria for diabetic ketoacidosis are blood glucose greater than 250 mg/dl, arterial pH less than 7.3, serum bicarbonate less than 15 mEq/l, and the presence of ketonemia or ketonuria.

• #2 Diabetic Ketoacidosis (DKA) – Warning Signs, Causes & Prevention

  https://diabetes.org/about-diabetes/complications/ketoacidosis-dka/dka-ketoacidosis-ketones

  Diabetic ketoacidosis (DKA) is life-threatening. […] DKA is caused by an overload of ketones present in your blood. […] High levels of ketones can poison the body. […] DKA may happen to anyone with diabetes, though it is rare in people with type 2. […] Treatment for DKA usually takes place in the hospital. […] You can detect ketones with a simple urine test using a test strip, similar to a blood testing strip. […] Many experts advise to check your urine for ketones when your blood glucose is more than 240 mg/dl. […] Call your health care provider at once if you experience the following conditions: Your urine tests show high levels of ketones. […] Do NOT exercise when your urine tests show ketones and your blood glucose is high. […] Here are three basic reasons for moderate or large amounts of ketones: Not enough insulin. […] Not enough food. […] Insulin reaction (low blood glucose).

• #3 Diabetic Ketoacidosis | AAFP

  https://www.aafp.org/pubs/afp/issues/2005/0501/p1705.html

  A diagnosis of diabetic ketoacidosis requires the patients plasma glucose concentration to be above 250 mg per dL (although it usually is much higher), the pH level to be less than 7.30, and the bicarbonate level to be 18 mEq per L or less. […] Beta-hydroxybutyrate is a better measurement of the degree of ketosis than serum ketones. […] Use of a standard protocol provides consistent results in treating DKA. […] An evidence-based guideline for the management of DKA from the American Diabetes Association (ADA) is the basis for much of this article. […] The severity of DKA is determined primarily by the pH level, bicarbonate level, and mental status, and not by the blood glucose measurement. […] Beta-hydroxybutyrate accounts for about 75 percent of ketones in ketoacidosis, and when available it is preferred for monitoring DKA over the nitroprusside method, which only measures acetoacetate. […] A blood glucose concentration of less than 200 mg per dL, a bicarbonate level of 18 mEq per L or greater, and a venous pH level of greater than 7.3 indicate that the DKA has resolved.

• #4 Diabetic Ketoacidosis: Evaluation and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/0301/p337.html

  Diabetic ketoacidosis is characterized by a serum glucose level greater than 250 mg per dL, a pH less than 7.3, a serum bicarbonate level less than 18 mEq per L, an elevated serum ketone level, and dehydration. […] Measurement of A1C, blood urea nitrogen, creatinine, serum glucose, electrolytes, pH, and serum ketones; complete blood count; urinalysis; electrocardiography; and calculation of anion gap and osmolar gap can differentiate diabetic ketoacidosis from hyperosmolar hyperglycemic state, gastroenteritis, starvation ketosis, and other metabolic syndromes, and can assist in diagnosing comorbid conditions. […] The diagnosis of DKA is based on an elevated serum glucose level (greater than 250 mg per dL [13.88 mmol per L]), an elevated serum ketone level, a pH less than 7.3, and a serum bicarbonate level less than 18 mEq per L (18 mmol per L).

• #5 Diagnosis of diabetic ketoacidosis – Primary Care Notebook

  https://primarycarenotebook.com/pages/diabetes-and-endocrinology/diagnosis-of-diabetic-ketoacidosis

  The diagnostic criteria for diabetic ketoacidosis are: ketonaemia 3 mmol /l and over or significant ketonuria (more than 2 + on standard urine sticks) […] blood glucose over 11 mmol /l or known diabetes mellitus […] venous bicarbonate (HCO3 ) ) below 15 mmol /l and /or venous pH less than 7.3. The American Diabetes Association diagnostic criteria for DKA are as follows: elevated serum glucose level (greater than 250 mg per dL [13.88 mmol per L]) […] an elevated serum ketone level […] a pH less than 7.3 and […] a serum bicarbonate level less than 18 mEq per L (18 mmol per L). DKA can be classified according to the severity into mild, moderate and severe.

• #6 Diabetic ketoacidosis – Wikipedia

  https://en.wikipedia.org/wiki/Diabetic_ketoacidosis

  Diabetic ketoacidosis may be diagnosed when the combination of hyperglycemia (high blood sugars), ketones in the blood or on urinalysis and acidosis are demonstrated. […] A pH measurement is performed to detect acidosis. Blood from a vein is adequate, as there is little difference between the arterial and the venous pH; arterial samples are only required if there are concerns about oxygen levels. […] Diabetic ketoacidosis is distinguished from other diabetic emergencies by the presence of large amounts of ketones in blood and urine, and marked metabolic acidosis. Hyperosmolar hyperglycemic state (HHS, sometimes labeled „hyperosmolar non-ketotic state” or HONK) is much more common in type 2 diabetes and features increased plasma osmolarity (above 320 mosm/kg) due to profound dehydration and concentration of the blood; mild acidosis and ketonemia may occur in this state, but not to the extent observed in DKA.

• #7 Diabetic ketoacidosis – Wikipedia

  https://en.wikipedia.org/wiki/Diabetic_ketoacidosis

  The American Diabetes Association categorizes DKA in adults into one of three stages of severity: Mild: blood pH mildly decreased to between 7.25 and 7.30 (normal 7.35-7.45); serum bicarbonate decreased to 15-18 mmol/L (normal above 20); the person is alert. […] Moderate: pH 7.00-7.25, bicarbonate 10-15, mild drowsiness may be present. […] Severe: pH below 7.00, bicarbonate below 10, stupor or coma may occur.

• #8 Diabetic Ketoacidosis

  https://fpnotebook.com/Endo/DM/DbtcKtcds.htm

  Diagnosis: Criteria – Hyperglycemia, Ketosis, Acidosis […] Blood Glucose 250 mg/dl (200 mg/dl in children) […] Glucose is normal in Euglycemic Ketoacidosis […] Metabolic Acidosis […] Serum pH 7.30 or […] Serum Bicarbonate 18 meq/L (prior guidelines used 15 meq/L) […] Serum Ketones or Beta hydroxybutyrate […] Increased Serum Ketones (3-4 mmol/L or 1:2 dilution) […] Anion Gap (using uncorrected Serum Sodium) […] Anion Gap without Potassium in calculation: 12 mEq/L […] Anion Gap with Potassium in calculation (or lab calculated): 15 to 17 mEq/L […] […] […] Evaluation: Severity […] Arterial pH (or venous pH) in Adults (ADA) […] Mild DKA: 7.25 to 7.30 […] Moderate DKA: 7.00 to 7.24 […] Severe DKA: 7.00 […] Arterial pH (or venous pH) in Infants and Children (ISPAD, NICE)

• #9 Diabetic ketoacidosis – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/diabetic-ketoacidosis/diagnosis-treatment/drc-20371555

  A physical exam and blood tests can help diagnose diabetic ketoacidosis. In some cases, other tests may be needed to help find what caused the diabetic ketoacidosis. […] Blood tests used in the diagnosis of diabetic ketoacidosis will measure: […] Tests that can help find health problems that might have contributed to diabetic ketoacidosis and check for complications might include:

• #10 Diabetes-Related Ketoacidosis (DKA): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/21945-diabetic-ketoacidosis-dka

  Diabetes-related ketoacidosis (DKA) is a life-threatening complication that affects people with diabetes or undiagnosed diabetes. It requires immediate medical attention. […] Healthcare providers diagnose diabetes-related ketoacidosis if you have the following four conditions: Your blood glucose (sugar) level is above 250 mg/dL. Its possible to have DKA if your blood sugar is lower than 250 mg/dL. This is euglycemic diabetes-related ketoacidosis (euDKA). Its not as common. […] In the hospital, healthcare providers may use the following tests to diagnose DKA: Blood glucose test. Ketone testing (through a urine or blood test). Arterial blood gas (ABG). Basic metabolic panel (BMP). Blood pressure measurement. Osmolality blood test. […] If you have diabetes and identify DKA early enough, you may be able to treat it from home with specific instructions from your healthcare provider.

• #11 Diabetic Ketoacidosis (DKA) Workup: Approach Considerations, Plasma Glucose Study, Urine Dipstick Testing

  https://emedicine.medscape.com/article/118361-workup

  Diabetic ketoacidosis is typically characterized by hyperglycemia of over 250 mg/dL, a bicarbonate level of less than 18 mEq/L, and a pH less than 7.30, with ketonemia and ketonuria. […] Laboratory studies for diabetic ketoacidosis (DKA) should be scheduled as follows: Blood tests for glucose every 1-2 h until patient is stable, then every 4-6 h; Serum electrolyte determinations every 1-2 h until patient is stable, then every 4-6 h; Initial blood urea nitrogen (BUN); Initial arterial blood gas (ABG) measurements, followed with bicarbonate as necessary. […] In patients with DKA, arterial blood gases (ABGs) frequently show typical manifestations of metabolic acidosis, low bicarbonate, and low pH (less than 7.3). […] Serum potassium levels initially are high or within the reference range in patients with DKA.

• #12 Diabetic Ketoacidosis | Diagnosis | UK Healthcare

  https://ukhealthcare.uky.edu/barnstable-brown-diabetes-center/diabetes-complications/diabetic-ketoacidosis/diagnosis

  If your health care provider believes you may have diabetic ketoacidosis, you will need certain exams and tests to be sure. […] Your provider may do the following tests to diagnose DKA: […] Arterial blood gas. A blood sample to test for acidity […] Basic metabolic panel. A group of blood tests that measure kidney function, sodium and potassium levels and acidity […] Blood glucose test. A blood test that measures glucose levels […] Ketone testing. Usually done first. If urine tests positive, a blood test is done to check for ketones.

• #13 Diabetic Ketoacidosis | AAFP

  https://www.aafp.org/pubs/afp/issues/2005/0501/p1705.html

  A diagnosis of diabetic ketoacidosis requires the patients plasma glucose concentration to be above 250 mg per dL (although it usually is much higher), the pH level to be less than 7.30, and the bicarbonate level to be 18 mEq per L or less. […] Beta-hydroxybutyrate is a better measurement of the degree of ketosis than serum ketones. […] Use of a standard protocol provides consistent results in treating DKA. […] An evidence-based guideline for the management of DKA from the American Diabetes Association (ADA) is the basis for much of this article. […] The severity of DKA is determined primarily by the pH level, bicarbonate level, and mental status, and not by the blood glucose measurement. […] Beta-hydroxybutyrate accounts for about 75 percent of ketones in ketoacidosis, and when available it is preferred for monitoring DKA over the nitroprusside method, which only measures acetoacetate. […] A blood glucose concentration of less than 200 mg per dL, a bicarbonate level of 18 mEq per L or greater, and a venous pH level of greater than 7.3 indicate that the DKA has resolved.

• #14 Diabetic ketoacidosis – Tests | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/162/investigations

  A plasma glucose test should be performed as an initial laboratory evaluation. In DKA, it is usually 250 mg/dL with acidosis and ketonemia. […] Acidosis is essential for the diagnosis of DKA. Arterial pH measurement is necessary for diagnosis of DKA, but venous pH is recommended for monitoring treatment, due to the pain and risk of infection in obtaining frequent arterial samples. […] There are three main ketones that are produced in DKA that can be measured: acetone, acetoacetate, and beta-hydroxybutyrate (BOHB). […] Therefore, serum ketone measurement by usual laboratory techniques has a high specificity, but low sensitivity for the diagnosis of DKA; hence a negative test for serum ketones does not exclude DKA. […] During the treatment of DKA, BOHB is converted to acetoacetate, which is detected by the nitroprusside method. […] Glucose and ketones are typical findings in DKA. […] Anion gap is calculated by subtracting the sum of serum chloride and bicarbonate from measured sodium concentration. […] Elevated anion gap (10-12 mEq/L). […] MI is a common precipitant of DKA in diabetic patients.

• #15 Diabetic Ketoacidosis (DKA) – Endocrine and Metabolic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/diabetes-mellitus-and-disorders-of-carbohydrate-metabolism/diabetic-ketoacidosis-dka

  Diabetic ketoacidosis (DKA) is diagnosed by detection of hyperketonemia and anion gap metabolic acidosis in the presence of hyperglycemia. […] DKA is diagnosed by an arterial pH 7.30 with an anion gap 12 and serum ketones. […] A presumptive diagnosis may be made when urine glucose and ketones are positive on urinalysis. […] Blood beta-hydroxybutyrate can be measured, or treatment can be initiated based on clinical suspicion and the presence of anion gap acidosis if serum or urine ketones are low. […] Symptoms and signs of a triggering illness should be pursued with appropriate studies (eg, cultures, imaging studies). Adults should have an ECG to screen for acute myocardial infarction and to help determine the significance of abnormalities in serum potassium.

• #16 Diabetic Ketoacidosis (DKA) Workup: Approach Considerations, Plasma Glucose Study, Urine Dipstick Testing

  https://emedicine.medscape.com/article/118361-workup

  In patients with diabetic ketoacidosis, the anion gap is elevated ([Na + K] – [Cl + HCO3] greater than 10 mEq/L in mild cases and greater than 12 mEq/L in moderate and severe cases). […] Even in the absence of infection, the CBC shows an increased white blood cell (WBC) count in patients with diabetic ketoacidosis. […] BUN frequently is increased in patients with diabetic ketoacidosis. […] Plasma osmolarity usually is increased (greater than 290 mOsm/L) in patients with diabetic ketoacidosis. […] Urine and blood culture findings help to identify any possible infecting organisms in patients with diabetic ketoacidosis. […] Hyperamylasemia may be seen in patients with diabetic ketoacidosis, even in the absence of pancreatitis. […] If the patient is at risk for hypophosphatemia (eg, poor nutritional status, chronic alcoholism), then the serum phosphorous level should be determined.

• #17 Adult Diabetic Ketoacidosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK560723/

  The majority of patients with DKA who present to the hospital are found to have leukocytosis. […] Other tests like cultures of urine, sputum, and blood, serum lipase, and chest radiograph may need to be performed depending upon the case. […] Fluid resuscitation and maintenance, insulin therapy, electrolyte replacement, and supportive care are the mainstays of management in diabetic ketoacidosis. […] Immediate fluid resuscitation is vital to correct hypovolemia, restore tissue perfusion, and to clear ketones. […] Intravenous insulin by continuous infusion is the standard of care. […] Patients with DKA should be treated with insulin until resolution. […] Criteria for resolution of ketoacidosis include blood glucose less than 200 mg/dl and two of the following criteria: a serum bicarbonate level =more than 15 mEq/l, a venous pH more than 7.3, or a calculated anion gap equal or less than 12 mEq/l.

• #18 Diabetic Ketoacidosis (DKA) Workup: Approach Considerations, Plasma Glucose Study, Urine Dipstick Testing

  https://emedicine.medscape.com/article/118361-workup

  Chest radiography should be used to rule out pulmonary infection such as pneumonia. […] An MRI is helpful in detecting early cerebral edema; it should be ordered only if altered consciousness is present. […] The threshold should be low for obtaining a head CT scan in children with diabetic ketoacidosis who have altered mental status, as this may be caused by cerebral edema. […] DKA may be precipitated by a cardiac event, and the physiological disturbances of DKA may cause cardiac complications.

• #19 Diabetic Ketoacidosis (DKA) Workup: Approach Considerations, Plasma Glucose Study, Urine Dipstick Testing

  https://emedicine.medscape.com/article/118361-workup

  Chest radiography should be used to rule out pulmonary infection such as pneumonia. […] An MRI is helpful in detecting early cerebral edema; it should be ordered only if altered consciousness is present. […] The threshold should be low for obtaining a head CT scan in children with diabetic ketoacidosis who have altered mental status, as this may be caused by cerebral edema. […] DKA may be precipitated by a cardiac event, and the physiological disturbances of DKA may cause cardiac complications.

• #20 Diabetes-Related Ketoacidosis (DKA): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/21945-diabetic-ketoacidosis-dka

  Diabetes-related ketoacidosis (DKA) is a life-threatening complication that affects people with diabetes or undiagnosed diabetes. It requires immediate medical attention. […] Healthcare providers diagnose diabetes-related ketoacidosis if you have the following four conditions: Your blood glucose (sugar) level is above 250 mg/dL. Its possible to have DKA if your blood sugar is lower than 250 mg/dL. This is euglycemic diabetes-related ketoacidosis (euDKA). Its not as common. […] In the hospital, healthcare providers may use the following tests to diagnose DKA: Blood glucose test. Ketone testing (through a urine or blood test). Arterial blood gas (ABG). Basic metabolic panel (BMP). Blood pressure measurement. Osmolality blood test. […] If you have diabetes and identify DKA early enough, you may be able to treat it from home with specific instructions from your healthcare provider.

• #21 Diabetic ketoacidosis – Diagnosis Approach | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/162/diagnosis-approach

  The symptoms of DKA usually develop rapidly over 1 day or less. DKA may be the initial presentation in up to 25% of people with newly diagnosed diabetes. […] Hyperglycemia is a key diagnostic criterion for DKA; however, a wide range of plasma glucose levels can be present on admission, and approximately 10% of DKA patients present with glucose 250 mg/dL (euglycemic DKA). […] Arterial blood gas (ABG) shows a metabolic acidosis, which is essential for the diagnosis of DKA. Arterial pH measurement is necessary for diagnosis of DKA, but venous pH is recommended for monitoring treatment, due to the pain and risk of infection in obtaining frequent arterial samples. […] The calculated serum anion gap in mEq/L (serum sodium – [serum chloride + bicarbonate]) gives an estimate of the unmeasured anions in plasma, which in DKA are ketoacids. The anion gap is typically more than 10 to 12 mEq/L in DKA. […] Normalization of the anion gap reflects correction of the ketoacidosis as these anions are removed from the blood.

• #22 :: Clinical and Experimental Emergency Medicine

  https://www.ceemjournal.org/m/journal/view.php?doi=10.15441/ceem.22.410

  Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes mellitus that can occur in patients with type 1 or type 2 diabetes. The triad of hyperglycemia, metabolic acidosis with an increased anion gap, and ketosis heralds the familiar clinical presentation of DKA. […] The most important step in diagnosis of eu-DKA is considering it as an option and not being falsely reassured by the presence of normoglycemia. Any patient with diabetes demonstrating these symptoms should be screened for eu-DKA with blood pH and blood or urine ketone testing, although eu-DKA may be the first presentation of diabetes. A patient with eu-DKA will typically have normoglycemia in the presence of metabolic acidosis (pH less than 7.3) and decreased blood bicarbonate (less than 18 mmol/L).

• #23 Just the Facts: Diagnosis and treatment of diabetic ketoacidosis in the emergency department | Canadian Journal of Emergency Medicine | Cambridge Core

  https://www.cambridge.org/core/journals/canadian-journal-of-emergency-medicine/article/just-the-facts-diagnosis-and-treatment-of-diabetic-ketoacidosis-in-the-emergency-department/7CC2F33ED7D67558F137F48706F9CB8B

  A 21-year-old male with known type 1 diabetes mellitus presented to the emergency department (ED) with two days of vomiting, polyuria, and polydipsia after several days of viral upper respiratory tract infection symptoms. […] As the diagnostic criteria for diabetic ketoacidosis are not well defined, it is important to keep a high index of suspicion. […] Serum pH and bicarbonate are usually low (7.30 and 15.0 mmol/L, respectively), and serum or urine ketones are positive. Typically, the anion gap is elevated (12 mmol/L), serum ketones or beta-hydroxybutyrate are present, and serum blood glucose is increased (11 mmol/L); however, normal blood glucose does not preclude the diagnosis of diabetic ketoacidosis as euglycemic diabetic ketoacidosis may occur in specific instances (e.g., pregnancy, sodium-glucose co-transporter 2 inhibitor use, food restriction, and alcohol use).

• #24 Euglycemic diabetic ketoacidosis: A missed diagnosis

  https://www.wjgnet.com/1948-9358/full/v12/i5/514.htm

  Euglycemic diabetic ketoacidosis (DKA) is an acute life-threatening metabolic emergency characterized by ketoacidosis and relatively lower blood glucose (less than 11 mmol/L). The absence of hyperglycemia is a conundrum for physicians in the emergency department and intensive care units; it may delay diagnosis and treatment causing worse outcomes. Euglycemic DKA is a diagnosis of exclusion and should be considered in the differential diagnosis of a sick patient with a history of diabetes mellitus despite lower blood glucose or absent urine ketones. The diagnostic workup includes arterial blood gas for metabolic acidosis, serum ketones and exclusion of other causes of high anion gap metabolic acidosis. […] Euglycemic DKA is an acute life-threatening medical emergency. The absence of hyperglycemia delays euglycemic DKA diagnosis in the emergency department or intensive care unit. However, euglycemic DKA is a diagnosis of exclusion, and other causes of high anion gap metabolic acidosis must be excluded. […] Unexplained high anion gap metabolic acidosis in a patient with DM and associated risk factors should raise suspicion of euglycemic DKA. A detailed history of risk factors like pregnancy, surgery, fasting, infections and SGLT-2 inhibitors should be evaluated.

• #25 :: Clinical and Experimental Emergency Medicine

  https://www.ceemjournal.org/m/journal/view.php?doi=10.15441/ceem.22.410

  Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes mellitus that can occur in patients with type 1 or type 2 diabetes. The triad of hyperglycemia, metabolic acidosis with an increased anion gap, and ketosis heralds the familiar clinical presentation of DKA. […] The most important step in diagnosis of eu-DKA is considering it as an option and not being falsely reassured by the presence of normoglycemia. Any patient with diabetes demonstrating these symptoms should be screened for eu-DKA with blood pH and blood or urine ketone testing, although eu-DKA may be the first presentation of diabetes. A patient with eu-DKA will typically have normoglycemia in the presence of metabolic acidosis (pH less than 7.3) and decreased blood bicarbonate (less than 18 mmol/L).

• #26 Diabetic Ketoacidosis (DKA) Workup: Approach Considerations, Plasma Glucose Study, Urine Dipstick Testing

  https://emedicine.medscape.com/article/118361-workup

  Diabetic ketoacidosis is typically characterized by hyperglycemia of over 250 mg/dL, a bicarbonate level of less than 18 mEq/L, and a pH less than 7.30, with ketonemia and ketonuria. […] Laboratory studies for diabetic ketoacidosis (DKA) should be scheduled as follows: Blood tests for glucose every 1-2 h until patient is stable, then every 4-6 h; Serum electrolyte determinations every 1-2 h until patient is stable, then every 4-6 h; Initial blood urea nitrogen (BUN); Initial arterial blood gas (ABG) measurements, followed with bicarbonate as necessary. […] In patients with DKA, arterial blood gases (ABGs) frequently show typical manifestations of metabolic acidosis, low bicarbonate, and low pH (less than 7.3). […] Serum potassium levels initially are high or within the reference range in patients with DKA.

• #27 Adult Diabetic Ketoacidosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK560723/

  The majority of patients with DKA who present to the hospital are found to have leukocytosis. […] Other tests like cultures of urine, sputum, and blood, serum lipase, and chest radiograph may need to be performed depending upon the case. […] Fluid resuscitation and maintenance, insulin therapy, electrolyte replacement, and supportive care are the mainstays of management in diabetic ketoacidosis. […] Immediate fluid resuscitation is vital to correct hypovolemia, restore tissue perfusion, and to clear ketones. […] Intravenous insulin by continuous infusion is the standard of care. […] Patients with DKA should be treated with insulin until resolution. […] Criteria for resolution of ketoacidosis include blood glucose less than 200 mg/dl and two of the following criteria: a serum bicarbonate level =more than 15 mEq/l, a venous pH more than 7.3, or a calculated anion gap equal or less than 12 mEq/l.

• #28 Diabetic ketoacidosis

  https://pch.health.wa.gov.au/For-health-professionals/Emergency-Department-Guidelines/Diabetic-ketoacidosis

  Patients having IV insulin infusion must be managed in PCC. […] Insulin infusion at a rate of 4: 5 years: 0.05 units/kg/hour, 5 years: 0.1 units/kg/hour (maximum 5 units/hour). […] When the ketoacidosis is corrected the insulin infusion may be reduced if the blood glucose level is less than 5mmol/L and glucose is being infused. […] If the blood glucose level does not decrease after the first 4 hours of the infusion, consider increasing the infusion rate e.g. in a child 5 years increase to 0.15 units/kg/hour; seek advice from intensivist or endocrinologist for a younger child. […] Bicarbonate administration is not routinely recommended as it may cause paradoxical Central Nervous System (CNS) acidosis. Continuing acidosis indicates either insufficient fluid or, more likely, inadequate insulin replacement. […] Monitoring blood glucose and ketone levels hourly while on insulin infusion.

• #29 Diabetic Ketoacidosis | AAFP

  https://www.aafp.org/pubs/afp/issues/2005/0501/p1705.html

  A diagnosis of diabetic ketoacidosis requires the patients plasma glucose concentration to be above 250 mg per dL (although it usually is much higher), the pH level to be less than 7.30, and the bicarbonate level to be 18 mEq per L or less. […] Beta-hydroxybutyrate is a better measurement of the degree of ketosis than serum ketones. […] Use of a standard protocol provides consistent results in treating DKA. […] An evidence-based guideline for the management of DKA from the American Diabetes Association (ADA) is the basis for much of this article. […] The severity of DKA is determined primarily by the pH level, bicarbonate level, and mental status, and not by the blood glucose measurement. […] Beta-hydroxybutyrate accounts for about 75 percent of ketones in ketoacidosis, and when available it is preferred for monitoring DKA over the nitroprusside method, which only measures acetoacetate. […] A blood glucose concentration of less than 200 mg per dL, a bicarbonate level of 18 mEq per L or greater, and a venous pH level of greater than 7.3 indicate that the DKA has resolved.

• #30 Diabetes-Related Ketoacidosis (DKA): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/21945-diabetic-ketoacidosis-dka

  Hospital treatment of DKA includes: IV fluids: IV fluids help to correct dehydration, clear ketones through your pee and correct electrolyte imbalances. Insulin: Your healthcare team may give you insulin through an IV or as a needle injection (subcutaneous shot). […] With prompt treatment, recovery from DKA typically happens within 24 hours. Full treatment of DKA happens when your blood sugar is less than 200 mg/dL and your blood pH is higher than 7.3. […] If you have diabetes, taking the following actions can help prevent DKA: Checking your blood sugar often: Checking your blood sugar with a glucose meter and/or using a CGM is crucial to managing diabetes and preventing complications. […] With prompt treatment, most people recover from diabetes-related ketoacidosis within a day. Sometimes, it takes longer.

• #31 Adult Diabetic Ketoacidosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK560723/

  The majority of patients with DKA who present to the hospital are found to have leukocytosis. […] Other tests like cultures of urine, sputum, and blood, serum lipase, and chest radiograph may need to be performed depending upon the case. […] Fluid resuscitation and maintenance, insulin therapy, electrolyte replacement, and supportive care are the mainstays of management in diabetic ketoacidosis. […] Immediate fluid resuscitation is vital to correct hypovolemia, restore tissue perfusion, and to clear ketones. […] Intravenous insulin by continuous infusion is the standard of care. […] Patients with DKA should be treated with insulin until resolution. […] Criteria for resolution of ketoacidosis include blood glucose less than 200 mg/dl and two of the following criteria: a serum bicarbonate level =more than 15 mEq/l, a venous pH more than 7.3, or a calculated anion gap equal or less than 12 mEq/l.

• #32 Diabetic Ketoacidosis (DKA) – Endocrinology Advisor

  https://www.endocrinologyadvisor.com/ddi/diabetic-ketoacidosis-dka/

  In addition to serum glucose, ketones, and -hydroxybutyrate levels, other serum chemistry tests should be part of the diagnostic workup. Patients often experience electrolyte changes as a secondary effect of dehydration and acid-base alterations. […] A wide range of conditions need to be considered in the differential diagnosis of DKA, several of which are characterized by metabolic acidosis. […] The goals of pharmacotherapy for DKA are to correct volume status, hyperglycemia, electrolyte abnormalities, ketoacidosis, and any precipitating factors. Treatment begins with fluid therapy, followed by insulin therapy and potassium replacement, and for select patients might include bicarbonate therapy or phosphate replacement. […] Diabetic ketoacidosis can be considered resolved when a patient has a blood glucose level 200 mg/dL and at least 2 of the following: Serum bicarbonate level greater than 15 mmol/L; Venous pH greater than 7.3; and Anion gap (calculated) less than or equal to 12 mmol/L.

• #33 Diabetic ketoacidosis: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000320.htm

  Diabetic ketoacidosis (DKA) is a life-threatening problem that affects people with diabetes. […] Ketone testing may be used in type 1 diabetes to check for early ketoacidosis. The ketone test is usually done using a urine sample or a blood sample. […] Ketone testing is usually done when DKA is suspected: […] Other tests for ketoacidosis include: […] DKA is a medical emergency. Contact your provider if you notice symptoms of DKA. […] If you have diabetes, learn to recognize the signs and symptoms of DKA. Know when to test for ketones, such as when you are sick.

• #34 Diabetic Ketoacidosis (DKA) – Warning Signs, Causes & Prevention

  https://diabetes.org/about-diabetes/complications/ketoacidosis-dka/dka-ketoacidosis-ketones

  Diabetic ketoacidosis (DKA) is life-threatening. […] DKA is caused by an overload of ketones present in your blood. […] High levels of ketones can poison the body. […] DKA may happen to anyone with diabetes, though it is rare in people with type 2. […] Treatment for DKA usually takes place in the hospital. […] You can detect ketones with a simple urine test using a test strip, similar to a blood testing strip. […] Many experts advise to check your urine for ketones when your blood glucose is more than 240 mg/dl. […] Call your health care provider at once if you experience the following conditions: Your urine tests show high levels of ketones. […] Do NOT exercise when your urine tests show ketones and your blood glucose is high. […] Here are three basic reasons for moderate or large amounts of ketones: Not enough insulin. […] Not enough food. […] Insulin reaction (low blood glucose).

• #35 Diabetic Ketoacidosis (DKA): Causes, Symptoms, Treatments

  https://www.webmd.com/diabetes/ketoacidosis

  If you have diabetes, its important to follow advice from your doctor about when to test for ketones. In general, you should test for ketones in these situations: If your blood sugar is 240 mg/dL or more. You should test your blood sugar and ketones again 30 minutes after your first high reading. […] If you are sick, check your ketones every 4-6 hours. […] If you have any symptoms of DKA.

• #36 Diabetic ketoacidosis – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/diabetic-ketoacidosis/symptoms-causes/syc-20371551

  Diabetic ketoacidosis is a serious complication of diabetes. […] If you have diabetes or you’re at risk of diabetes, learn the warning signs of diabetic ketoacidosis and when to seek emergency care. […] More-certain signs of diabetic ketoacidosis which can show up in home blood and urine test kits include: High blood sugar level, High ketone levels in urine. […] Contact your health care provider right away if: Your urine ketone level is moderate or high. […] Seek emergency care if: You have ketones in your urine and can’t reach your health care provider for advice. […] Diabetic ketoacidosis usually happens after: An illness. […] Diabetic ketoacidosis can occur with type 2 diabetes. In some cases, diabetic ketoacidosis may be the first sign of having diabetes. […] Diabetic ketoacidosis is treated with fluids, electrolytes such as sodium, potassium and chloride and insulin. […] If your ketone level is moderate or high, contact your health care provider right away or seek emergency care. […] If you think you have diabetic ketoacidosis because your blood sugar is high and you have too many ketones in your urine, seek emergency care.

• #37 Diabetic Ketoacidosis (DKA): Causes, Symptoms, Treatments

  https://www.webmd.com/diabetes/ketoacidosis

  Testing your pee (urinalysis). Looking at a sample of pee helps your doctor measure your ketones, sugar, and other nutrients. They might also measure how much pee you make (to make sure that you arent getting dehydrated) and test for infections. […] Other diagnostic testing for DKA includes: Ketone test, Arterial blood gas, Blood pressure, Osmolality. […] Your doctor might give you a chest X-ray, CAT scan, or MRI to rule out other problems or get more information about how DKA is impacting you. They may also recommend tests for your heart (electrocardiogram, or ECG) to check how it’s working. […] Testing for ketones You can check yourself for ketones at home with a urine sample. You can buy kits for testing your pee over the counter. Some glucose meters can also test for ketones in the blood sample when you do a finger prick. Ask your doctor to show you how to do an at-home ketone test if you have any questions.

• #38 Adult diabetic ketoacidosis: Diagnosis, management and the importance of prevention – DiabetesontheNet

  https://diabetesonthenet.com/journal-diabetes-nursing/adult-diabetic-ketoacidosis-diagnosis-management-prevention/

  With the availability of blood ketone meters, there is now compelling evidence to support the use of this technology for diagnosis and management of DKA. […] Open discussions about the causation and associated problems is of paramount importance in the prevention of recurrent DKA and should be high on the healthcare professionals agenda. […] Illness management should be discussed at diagnosis and then at least annually, and there should be the opportunity to discuss, advise and assess the individuals understanding of how to prevent the risks of developing DKA. […] All healthcare professionals involved in diabetes management should consider the following measures to prevent and manage DKA: Review of education, including a post-DKA assessment. […] The role of the DSN is multifactorial.

• #39 Diabetic ketoacidosis – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/diabetic-ketoacidosis/symptoms-causes/syc-20371551

  Diabetic ketoacidosis is a serious complication of diabetes. […] If you have diabetes or you’re at risk of diabetes, learn the warning signs of diabetic ketoacidosis and when to seek emergency care. […] More-certain signs of diabetic ketoacidosis which can show up in home blood and urine test kits include: High blood sugar level, High ketone levels in urine. […] Contact your health care provider right away if: Your urine ketone level is moderate or high. […] Seek emergency care if: You have ketones in your urine and can’t reach your health care provider for advice. […] Diabetic ketoacidosis usually happens after: An illness. […] Diabetic ketoacidosis can occur with type 2 diabetes. In some cases, diabetic ketoacidosis may be the first sign of having diabetes. […] Diabetic ketoacidosis is treated with fluids, electrolytes such as sodium, potassium and chloride and insulin. […] If your ketone level is moderate or high, contact your health care provider right away or seek emergency care. […] If you think you have diabetic ketoacidosis because your blood sugar is high and you have too many ketones in your urine, seek emergency care.

• #40 Diabetic ketoacidosis

  https://www.nhs.uk/conditions/diabetic-ketoacidosis/

  Diabetic ketoacidosis (DKA) is a serious condition that can happen in people with diabetes. It’s where a lack of insulin causes harmful substances called ketones to build up in the blood. It can be life threatening and needs urgent treatment in hospital. […] If you have diabetes and have any of the symptoms of DKA, check your blood glucose. If it’s high, test for ketones if you can. […] If you have diabetic ketoacidosis (DKA) you’ll need to be admitted to hospital for urgent treatment. […] You’ll be monitored for complications, as DKA can sometimes affect your brain, heart or lungs. […] Testing for ketones will help you know when you need to take action, such as increasing your insulin dose.

• #41 Adult Diabetic Ketoacidosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK560723/

  Diabetic ketoacidosis (DKA) is characterized by uncontrolled hyperglycemia, metabolic acidosis, and increased body ketone concentration. […] DKA is a state of a relative or absolute insulin deficiency that is worsened by hyperglycemia, dehydration, and acidosis. […] This activity highlights the role of the interprofessional team in evaluating and managing patients suffering from this disorder in order to achieve the best outcomes. […] Diabetic ketoacidosis (DKA) is characterized by hyperglycemia, acidosis, and ketonemia. […] Common precipitating factors for DKA are non-compliance, new-onset diabetes, and other acute medical illness. […] The most common types of infections are pneumonia and urinary tract infections. […] Commonly accepted criteria for diabetic ketoacidosis are blood glucose greater than 250 mg/dl, arterial pH less than 7.3, serum bicarbonate less than 15 mEq/l, and the presence of ketonemia or ketonuria.

• #42 Detecting Diabetic Ketoacidosis with Infection: Combating a Life-Threatening Emergency with Practical Diagnostic Tools

  https://www.mdpi.com/2075-4418/13/14/2441

  Diabetic ketoacidosis is a common diabetic complication associated with patient morbidity and mortality. […] The most common DKA triggers are insulin therapy discontinuation and infections. […] Infection diagnosis is typically based on symptoms and secretion culture. […] An early diagnosis of infections may be challenging since specific symptoms of DKA are like that of infection, like fever, a raised leukocyte count, neutrophil percentage, C reactive protein (CRP), and procalcitonin (PCT). […] This study aims to shed light on the possible diagnostic tools that may be utilized in the emergency department of hospitals upon the admission of patients with DKA and infection. […] This narrative review focuses on identifying various diagnostic tools that can be used to diagnose and distinguish between DKA with and without infection. […] The presence of infection may further worsen this life-threatening condition, the diagnosis of which is also vital to decide upon the need to administer antibiotics. […] Therefore, using serum lactate cut-off points can help recognize and monitor the severity of DKA and the possible presence of sepsis in the emergency room. […] Another diagnostic tool that has been recommended for the diagnosis of DKA is PCT. […] Several studies have reported DKA to increase the production of cytokines. […] Therefore, DKA may cause an inflammatory environment and thus raise levels of PCT.

• #43 Diabetic ketoacidosis – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/diabetic-ketoacidosis/symptoms-causes/syc-20371551

  Diabetic ketoacidosis is a serious complication of diabetes. […] If you have diabetes or you’re at risk of diabetes, learn the warning signs of diabetic ketoacidosis and when to seek emergency care. […] More-certain signs of diabetic ketoacidosis which can show up in home blood and urine test kits include: High blood sugar level, High ketone levels in urine. […] Contact your health care provider right away if: Your urine ketone level is moderate or high. […] Seek emergency care if: You have ketones in your urine and can’t reach your health care provider for advice. […] Diabetic ketoacidosis usually happens after: An illness. […] Diabetic ketoacidosis can occur with type 2 diabetes. In some cases, diabetic ketoacidosis may be the first sign of having diabetes. […] Diabetic ketoacidosis is treated with fluids, electrolytes such as sodium, potassium and chloride and insulin. […] If your ketone level is moderate or high, contact your health care provider right away or seek emergency care. […] If you think you have diabetic ketoacidosis because your blood sugar is high and you have too many ketones in your urine, seek emergency care.

• #44 Diabetic ketoacidosis

  https://pch.health.wa.gov.au/For-health-professionals/Emergency-Department-Guidelines/Diabetic-ketoacidosis

  DKA is characterised by the triad of hyperglycaemia, metabolic acidosis and increased total body ketone concentration. DKA results from absolute or relative deficiency of circulating insulin and the effects of increased levels of counter-regulatory hormones. […] The biochemical criteria for the diagnosis of DKA: Hyperglycaemia: blood glucose level (BGL) 11 mmol/L, Ketonaemia (blood beta hydroxybutyrate 3 mmol/L or moderate or large ketonuria, Acidosis: venous pH 7.3 or bicarbonate 18 mmol/L. […] Confirm diagnosis and determine causes. […] Insulin is essential to switch off ketogenesis and reverse the ketoacidosis. […] Continuous low dose insulin is the preferred method. […] Venous pH 7.2 = intravenous insulin recommended with admission to PCC. […] Venous pH 7.2 = subcutaneous insulin and ward management.

• #45 Detecting Diabetic Ketoacidosis with Infection: Combating a Life-Threatening Emergency with Practical Diagnostic Tools

  https://www.mdpi.com/2075-4418/13/14/2441

  Diabetic ketoacidosis is a common diabetic complication associated with patient morbidity and mortality. […] The most common DKA triggers are insulin therapy discontinuation and infections. […] Infection diagnosis is typically based on symptoms and secretion culture. […] An early diagnosis of infections may be challenging since specific symptoms of DKA are like that of infection, like fever, a raised leukocyte count, neutrophil percentage, C reactive protein (CRP), and procalcitonin (PCT). […] This study aims to shed light on the possible diagnostic tools that may be utilized in the emergency department of hospitals upon the admission of patients with DKA and infection. […] This narrative review focuses on identifying various diagnostic tools that can be used to diagnose and distinguish between DKA with and without infection. […] The presence of infection may further worsen this life-threatening condition, the diagnosis of which is also vital to decide upon the need to administer antibiotics. […] Therefore, using serum lactate cut-off points can help recognize and monitor the severity of DKA and the possible presence of sepsis in the emergency room. […] Another diagnostic tool that has been recommended for the diagnosis of DKA is PCT. […] Several studies have reported DKA to increase the production of cytokines. […] Therefore, DKA may cause an inflammatory environment and thus raise levels of PCT.

• #46 Canine diabetic ketoacidosis | Academy EN

  https://vetfocus.royalcanin.com/en/scientific/canine-diabetic-ketoacidosis

  Up to 70% of DKA patients are in a state of decompensated DM because of concomitant pathologies responsible for increased insulin resistance common comorbidities are acute pancreatitis, bacterial urinary tract infection and hyperadrenocorticism. […] Therefore, once the patient is stable, further investigations (e.g., hematology, biochemistry, urine analysis with culture, pancreatic lipase serology, endocrine tests, imaging) are necessary in order to identify possible triggers. […] Insulin is essential to decrease gluconeogenesis, improve glucose utilization and to both reduce KB production and increase KB metabolism. […] Human guidelines advise initiation of insulin therapy after at least an hour of fluid therapy, and with a potassium value of at least 3.3-3.5 mEq/L. […] A veterinary study showed that starting insulin within 6 hours of hospital admission reduces time for DKA resolution (based on ketonuria) and does not increase the complication rate. […] Once ketoacidosis is resolved (AG 10-12 mEq/L, BHB 0.6 mmol/L, pH 7.3), glucose levels are well controlled, and patient is eating (or would eat at home) and drinking, long-acting insulin is started.

• #47 Detecting Diabetic Ketoacidosis with Infection: Combating a Life-Threatening Emergency with Practical Diagnostic Tools

  https://www.mdpi.com/2075-4418/13/14/2441

  Infection may be detected early in DKA patients by using biomarkers like procalcitonin, serum lactate, procalcitonin/lactate ratio, white blood cell count, neutrophil/lymphocyte ratio, and C reactive protein. […] The values of these biomarkers were found to be higher in patients suffering from DKA with infection when compared to DKA patients without infection. […] Several of these biomarkers need to be checked when the patient is admitted to the emergency department to determine whether DKA is further complicated with infection. […] If the presence of infection is properly diagnosed, then antibiotics may be used appropriately and antibiotic resistance can be avoided.

• #48 Adult Diabetic Ketoacidosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK560723/

  The majority of patients with DKA who present to the hospital are found to have leukocytosis. […] Other tests like cultures of urine, sputum, and blood, serum lipase, and chest radiograph may need to be performed depending upon the case. […] Fluid resuscitation and maintenance, insulin therapy, electrolyte replacement, and supportive care are the mainstays of management in diabetic ketoacidosis. […] Immediate fluid resuscitation is vital to correct hypovolemia, restore tissue perfusion, and to clear ketones. […] Intravenous insulin by continuous infusion is the standard of care. […] Patients with DKA should be treated with insulin until resolution. […] Criteria for resolution of ketoacidosis include blood glucose less than 200 mg/dl and two of the following criteria: a serum bicarbonate level =more than 15 mEq/l, a venous pH more than 7.3, or a calculated anion gap equal or less than 12 mEq/l.

• #49 Diabetic Ketoacidosis (DKA): Nursing Diagnoses, Care Plans, Assessment & Interventions | NurseTogether

  https://www.nursetogether.com/diabetic-ketoacidosis-dka-nursing-diagnosis-care-plan/

  Nursing interventions and care are essential for the patients recovery. […] The cornerstones of management in diabetic ketoacidosis are fluid resuscitation and maintenance, insulin therapy, electrolyte restoration, and supportive care. […] Patients with DKA may lose 10% to 15% of their body weight in fluid. Immediate fluid resuscitation is essential to reverse hypovolemia, restore tissue perfusion, and eliminate ketones. […] IV short-acting insulin by continuous infusion is recommended until the glucose level is below 200 mg/dL, plus two of the following: Serum bicarbonate level 15 mEq/L, pH 7.3, Anion gap 12 mEq/L. […] Administer electrolytes intravenously as prescribed to keep the heart, muscles, and nerve cells functioning normally. […] Administer IV fluid as ordered. Fluid resuscitation is crucial in the management of patients with DKA. IV fluids replace extravascular and intravascular fluids and electrolyte losses. […] Fluid replacement alone will begin to lower blood glucose. Initial isotonic therapy of 0.9% saline is recommended. A transition to a hypotonic solution such as 0.45% saline may be used as long as sodium levels remain normal.

• #50 Diabetic Ketoacidosis (DKA) – Endocrinology Advisor

  https://www.endocrinologyadvisor.com/ddi/diabetic-ketoacidosis-dka/

  Diabetic ketoacidosis (DKA) is an acute complication of diabetes that results from absolute or relative insulin deficiency. This article describes the presentation, diagnosis, and treatment of DKA. […] A complete laboratory investigation is necessary for diagnosis, including a metabolic panel, serum osmolality, serum ketones and -hydroxybutyrate, complete blood count, urinalysis, urine ketones, and arterial blood gases. To meet diagnostic criteria for DKA, a patients blood glucose must be greater than 250 mg/dL, the arterial pH must be 7.30 or less, and the bicarbonate level must be less than 15 mmol/L, although it may be less than 18 mmol/L in patients with mild cases of DKA. A urine test that is positive for both glucose and ketones supports a DKA diagnosis but is not required. […] A physical examination should include a thorough evaluation of the patients breathing and airway, circulation, mental state, volume status, and any signs of a precipitating condition. Upon examination, patients often demonstrate physical findings consistent with dehydration, such as tachycardia, hypotension, dry mucous membranes, poor skin turgor, and sunken eyes. Another characteristic symptom is a rapid and deep breathing pattern known as Kussmaul breathing.

• #51 Diabetic Ketoacidosis (DKA) Workup: Approach Considerations, Plasma Glucose Study, Urine Dipstick Testing

  https://emedicine.medscape.com/article/118361-workup

  In patients with diabetic ketoacidosis, the anion gap is elevated ([Na + K] – [Cl + HCO3] greater than 10 mEq/L in mild cases and greater than 12 mEq/L in moderate and severe cases). […] Even in the absence of infection, the CBC shows an increased white blood cell (WBC) count in patients with diabetic ketoacidosis. […] BUN frequently is increased in patients with diabetic ketoacidosis. […] Plasma osmolarity usually is increased (greater than 290 mOsm/L) in patients with diabetic ketoacidosis. […] Urine and blood culture findings help to identify any possible infecting organisms in patients with diabetic ketoacidosis. […] Hyperamylasemia may be seen in patients with diabetic ketoacidosis, even in the absence of pancreatitis. […] If the patient is at risk for hypophosphatemia (eg, poor nutritional status, chronic alcoholism), then the serum phosphorous level should be determined.

• #52 Diabetic Ketoacidosis (DKA) – Endocrinology Advisor

  https://www.endocrinologyadvisor.com/ddi/diabetic-ketoacidosis-dka/

  In addition to serum glucose, ketones, and -hydroxybutyrate levels, other serum chemistry tests should be part of the diagnostic workup. Patients often experience electrolyte changes as a secondary effect of dehydration and acid-base alterations. […] A wide range of conditions need to be considered in the differential diagnosis of DKA, several of which are characterized by metabolic acidosis. […] The goals of pharmacotherapy for DKA are to correct volume status, hyperglycemia, electrolyte abnormalities, ketoacidosis, and any precipitating factors. Treatment begins with fluid therapy, followed by insulin therapy and potassium replacement, and for select patients might include bicarbonate therapy or phosphate replacement. […] Diabetic ketoacidosis can be considered resolved when a patient has a blood glucose level 200 mg/dL and at least 2 of the following: Serum bicarbonate level greater than 15 mmol/L; Venous pH greater than 7.3; and Anion gap (calculated) less than or equal to 12 mmol/L.

• #53 Diabetic KetoAcidosis (DKA) – Diabetes Qualified

  https://www.diabetesqualified.com.au/diabetic-ketoacidosis-dka/

  The diagnosis of DKA is made when ketonaemia (blood ketones greater than 3.0 mmol/L) or significant ketonuria (more than 2+ ketones on a standard urine test) is present, along with elevated blood glucose levels (11.0 mmol/L) and metabolic acidosis. […] The biochemical criteria for diagnosis of DKA are a serum glucose level 11 mmol/L (as outlined above), venous pH 7.3 or bicarbonate 15 mmol/L. […] The severity of DKA is classified as mild, moderate, or severe based on the severity of metabolic acidosis (blood pH, bicarbonate, ketones) and the presence of altered mental status. […] Patients with low-normal or low serum potassium concentration on admission generally have severe total-body potassium deficiency and require careful cardiac monitoring and more vigorous potassium replacement, because treatment lowers potassium further and can provoke cardiac dysrhythmia. […] Criteria for the resolution of DKA include glucose 11.1mmol/L, serum bicarbonate 15 mmol/L, and venous pH 7.3.

• #54 Diabetic ketoacidosis

  https://www.nhs.uk/conditions/diabetic-ketoacidosis/

  Diabetic ketoacidosis (DKA) is a serious condition that can happen in people with diabetes. It’s where a lack of insulin causes harmful substances called ketones to build up in the blood. It can be life threatening and needs urgent treatment in hospital. […] If you have diabetes and have any of the symptoms of DKA, check your blood glucose. If it’s high, test for ketones if you can. […] If you have diabetic ketoacidosis (DKA) you’ll need to be admitted to hospital for urgent treatment. […] You’ll be monitored for complications, as DKA can sometimes affect your brain, heart or lungs. […] Testing for ketones will help you know when you need to take action, such as increasing your insulin dose.

• #55 Diabetic Ketoacidosis

  https://www.rch.org.au/clinicalguide/guideline_index/Diabetic_Ketoacidosis/

  RCH Health Professionals Clinical Practice Guidelines Diabetic Ketoacidosis […] The biochemical criteria for diagnosis of DKA are: […] Serum glucose 11 mmol/L […] Venous pH 7.3 or Bicarbonate 15 mmol/L […] Presence of ketonaemia/ketonuria […] Assessment of Dehydration […] History and examination are directed towards potential precipitants, assessment of severity, and detecting complications of DKA. […] Once DKA is confirmed, the following biochemical monitoring should be put in place to guide ongoing management. These will continue until resolution of DKA: […] Severity of DKA Assessed based on the more severe of these parameters: Venous pH Bicarbonate (mmol/L) Mild 7.3 15 Moderate 7.2 10 Severe 7.1 5 […] The most important complications of DKA and its treatment are: […] Cerebral oedema

• #56 Diabetic Ketoacidosis

  https://www.rch.org.au/clinicalguide/guideline_index/Diabetic_Ketoacidosis/

  Hypoglycaemia […] Hypo/hyperkalaemia […] Hypo/hypernatraemia […] Identify and Treat precipitating cause […] Assess for underlying infections and consider antibiotics after obtaining relevant cultures if appropriate. […] In children with known T1DM the most common cause of DKA is omission or significant reduction in recent insulin doses. […] Consider consultation with local paediatric team for […] All children with DKA […] All newly diagnosed diabetes mellitus […] Hyper/hyponatraemia.

• #57 Diabetes-Related Ketoacidosis (DKA): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/21945-diabetic-ketoacidosis-dka

  Hospital treatment of DKA includes: IV fluids: IV fluids help to correct dehydration, clear ketones through your pee and correct electrolyte imbalances. Insulin: Your healthcare team may give you insulin through an IV or as a needle injection (subcutaneous shot). […] With prompt treatment, recovery from DKA typically happens within 24 hours. Full treatment of DKA happens when your blood sugar is less than 200 mg/dL and your blood pH is higher than 7.3. […] If you have diabetes, taking the following actions can help prevent DKA: Checking your blood sugar often: Checking your blood sugar with a glucose meter and/or using a CGM is crucial to managing diabetes and preventing complications. […] With prompt treatment, most people recover from diabetes-related ketoacidosis within a day. Sometimes, it takes longer.

• #58 Adult Diabetic Ketoacidosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK560723/

  Education on the disease process of diabetes, including short and long term complications, should be given to all patients. […] Diabetic ketoacidosis is a life-threatening complication of diabetes, and any delay in treatment can lead to death. […] The disorder can present with varied signs and symptoms and affects many organs; thus, it is best managed by an interprofessional team dedicated to the management of patients with diabetes mellitus.

• #59 What Is Diabetic Ketoacidosis? DKA Symptoms & Signs

  https://www.emedicinehealth.com/diabetic_ketoacidosis/article_em.htm

  Insulin must not be delayed and must be given promptly as a continuous infusion (not as a bolus – a large dose given rapidly) to stop further ketone formation and to stabilize tissue function by driving available potassium back inside the body’s cells. […] People diagnosed with diabetic ketoacidosis are usually admitted into the hospital for treatment and may be admitted to the intensive care unit.

• #60 Pediatric Diabetic Ketoacidosis | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/26827

  Diabetic ketoacidosis (DKA) is a serious complication of relative insulin deficiency affecting primarily type-1 diabetes mellitus (DM). DKA can occur in type-2 DM when insulin levels fall far behind the body’s needs. DKA is so named due to high levels of water-soluble ketone bodies (KBs), leading to an acidotic physiologic state. According to the International Society for Pediatric and Adolescent Diabetes, DKA is defined by the presence of all of the following in a patient with diabetes: Hyperglycemia Blood glucose 200 mg/dL (11 mmol/L), Metabolic acidosis Venous pH 7.3 or serum bicarbonate 15 mEq/L (15 mmol/L), Ketosis Presence of ketones in the blood (3 mmol/L beta-hydroxybutyrate) or urine („moderate or large” urine ketones). DKA is definitively diagnosed by serology showing metabolic acidosis and hyperglycemia. Ketone testing can be helpful but is not necessary. Several point-of-care and laboratory tests aid in the diagnosis of DKA. These include: Anion gap: The anion gap is calculated as follows: (Na+K)-(Cl+HCO3). Ketoacids (primarily BHB) are unmeasured ions, leading to the gap in anions. The AG is normally between 6 mEq/L to 12 mEq/L, with levels above 15 typically present in DKA. Blood glucose: It is usually above 200 mg/dL (11 mmol/l) and may be above 1000 mg/dL. Pediatric patients have DKA with relatively mild elevations in blood glucose. Serum BHB concentration: BHB is usually above 31 mg/dL in these patients. DKA can be categorized as mild, moderate, and severe based on the following criteria: Venous pH 7.2 to 7.3, 7.1 to 7.2, 7.1. Serum bicarbonate (mEq/L) 10 to 15*, 5 to 9, 5*. Treatment for DKA begins with ABCs and fluid resuscitation. Insulin therapy, usually by continuous infusion, can begin once the patient is stabilized. DKA is frequently present at diagnosis of type 1 diabetes (in approximately 3% percent of children in the United States and Canada) and, along with its complications, is the most common cause of hospitalization, mortality, and morbidity in children with type 1 diabetes mellitus. The fatality rate is approximately 0.15-0.31% of cases.

• #61 Adult Diabetic Ketoacidosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK560723/

  Education on the disease process of diabetes, including short and long term complications, should be given to all patients. […] Diabetic ketoacidosis is a life-threatening complication of diabetes, and any delay in treatment can lead to death. […] The disorder can present with varied signs and symptoms and affects many organs; thus, it is best managed by an interprofessional team dedicated to the management of patients with diabetes mellitus.

• #62 Adult diabetic ketoacidosis: Diagnosis, management and the importance of prevention – DiabetesontheNet

  https://diabetesonthenet.com/journal-diabetes-nursing/adult-diabetic-ketoacidosis-diagnosis-management-prevention/

  The survival of people with DKA can depend on the ability of the individual and the professional to recognise its signs and symptoms. […] The guidance from JBDS stresses the importance of prompt diagnosis and intensive management. […] It is important to note that certain groups of people are at greater risk of developing DKA, such as those with eating disorders and/or mental health issues. […] The specialist diabetes team should always be involved as soon as possible and ideally within 24 hours because this has been demonstrated to be associated with a better patient experience and reduced length of stay. […] The JBDS guidance also encourages audit against defined standards. […] Education about self-managing diabetes in order to prevent DKA is essential to reduce the risk of developing this acute illness. Good self-monitoring and regular insulin doses according to need are the primary preventive measures for the condition.

• #63 Adult diabetic ketoacidosis: Diagnosis, management and the importance of prevention – DiabetesontheNet

  https://diabetesonthenet.com/journal-diabetes-nursing/adult-diabetic-ketoacidosis-diagnosis-management-prevention/

  With the availability of blood ketone meters, there is now compelling evidence to support the use of this technology for diagnosis and management of DKA. […] Open discussions about the causation and associated problems is of paramount importance in the prevention of recurrent DKA and should be high on the healthcare professionals agenda. […] Illness management should be discussed at diagnosis and then at least annually, and there should be the opportunity to discuss, advise and assess the individuals understanding of how to prevent the risks of developing DKA. […] All healthcare professionals involved in diabetes management should consider the following measures to prevent and manage DKA: Review of education, including a post-DKA assessment. […] The role of the DSN is multifactorial.

• #64 Adult diabetic ketoacidosis: Diagnosis, management and the importance of prevention – DiabetesontheNet

  https://diabetesonthenet.com/journal-diabetes-nursing/adult-diabetic-ketoacidosis-diagnosis-management-prevention/

  The role of the DSNs is such that they can influence care and potentially prevent re-admissions. […] The healthcare professional should ensure that they have the ability to provide support and education to people at risk of developing DKA and those that have had an episode of DKA; it is important to re-enforce the ongoing education to help reduce both the initial occurrence and recurrence of this often preventable life-threatening condition.

• #65 Adult diabetic ketoacidosis: Diagnosis, management and the importance of prevention – DiabetesontheNet

  https://diabetesonthenet.com/journal-diabetes-nursing/adult-diabetic-ketoacidosis-diagnosis-management-prevention/

  With the availability of blood ketone meters, there is now compelling evidence to support the use of this technology for diagnosis and management of DKA. […] Open discussions about the causation and associated problems is of paramount importance in the prevention of recurrent DKA and should be high on the healthcare professionals agenda. […] Illness management should be discussed at diagnosis and then at least annually, and there should be the opportunity to discuss, advise and assess the individuals understanding of how to prevent the risks of developing DKA. […] All healthcare professionals involved in diabetes management should consider the following measures to prevent and manage DKA: Review of education, including a post-DKA assessment. […] The role of the DSN is multifactorial.

• #66 Diabetic ketoacidosis diagnosis in a hospital setting

  https://www.degruyterbrill.com/document/doi/10.1515/jom-2023-0019/html?srsltid=AfmBOop5-72qviTf7zsFoTnX102MJW2llfLYnkToh3wLemDtzwwHiqLE

  Diabetic ketoacidosis (DKA) is an endocrine emergency that can occur in people with diabetes. Its incidence is estimated to be 220,340 hospital admissions each year. […] The aims of this study were to determine how often DKA is overdiagnosed in the context of other acute hyperglycemic emergencies, to describe the baseline characteristics of patients, to determine the hospital treatments for DKA, and to identify the frequency of endocrinology or diabetology consultation in the hospital setting. […] A total of 520 hospital admissions were included for review. DKA was incorrectly diagnosed in 28.4% of the hospital admissions reviewed, based on a review of the labs and DKA diagnostic criteria. […] Almost one third of hospital admissions for hyperglycemic emergencies were misdiagnosed and managed as DKA. DKA diagnostic criteria are specific; however, other diagnoses like hyperosmolar hyperglycemic syndrome (HHS), hyperglycemia, and euglycemic DKA can make an accurate diagnosis more complicated.

• #67 Diabetic ketoacidosis diagnosis in a hospital setting – Journal of Osteopathic Medicine

  https://jom.osteopathic.org/abstract/diabetic-ketoacidosis-diagnosis-in-a-hospital-setting/

  Diabetic ketoacidosis (DKA) is an endocrine emergency that can occur in people with diabetes. Its incidence is estimated to be 220,340 hospital admissions each year. The misdiagnosis of DKA in the setting of hyperglycemic emergencies results in overtreatment and unnecessary increases in healthcare utilization and costs. […] A total of 520 hospital admissions were included for review. DKA was incorrectly diagnosed in 28.4% of the hospital admissions reviewed, based on a review of the labs and DKA diagnostic criteria. […] Almost one third of hospital admissions for hyperglycemic emergencies were misdiagnosed and managed as DKA. DKA diagnostic criteria are specific; however, other diagnoses like hyperosmolar hyperglycemic syndrome (HHS), hyperglycemia, and euglycemic DKA can make an accurate diagnosis more complicated. Education directed at improving the diagnostic accuracy of DKA among healthcare providers is needed to improve diagnostic accuracy, ensure the appropriate use of hospital resources, and potentially reduce costs to the healthcare system.

• #68 Diabetic ketoacidosis diagnosis in a hospital setting

  https://www.degruyterbrill.com/document/doi/10.1515/jom-2023-0019/html?srsltid=AfmBOop5-72qviTf7zsFoTnX102MJW2llfLYnkToh3wLemDtzwwHiqLE

  The criteria for diagnosing DKA include a plasma glucose level over 250mg/dL, elevated serum ketone level, pH less than 7.3, and bicarbonate of less than 18mEq/L. […] The purpose of this study was to describe DKA diagnosis in a hospital setting. […] Overdiagnosis of DKA was seen more on the MSU, with 42.2% (n=92) of admissions being incorrectly diagnosed whereas overdiagnosis in the ICU was seen in 17.1% (n=49) of admissions. Accuracy of diagnosis revealed that 71.6% (n=372) of admissions were correctly diagnosed with DKA. […] Missing the diagnosis almost one third of the time demonstrates opportunity for provider education to review the criteria for diagnosis as well as billing accuracy to decrease overdiagnosis, improve patient care, and reduce healthcare costs.

• #69 Diabetic Ketoacidosis (DKA) – EMCrit Project

  https://emcrit.org/ibcc/dka/

  Elevated anion gap does not necessarily imply DKA! This is especially true among patients with chronic renal failure, who may have a chronically elevated anion gap. […] The urinary ketone dipstick tests for acetoacetate, which isn’t the main ketone in DKA (levels of beta-hydroxybutyrate are much higher). […] This test has a high sensitivity for DKA (98-99%), with urinary ketones are generally being 2+. […] The specificity of a positive measurement of urinary ketones is low, so a positive urinary measurement of ketones doesn’t establish a diagnosis of DKA. […] A strongly elevated beta-hydroxybutyrate level would support a diagnosis of DKA. […] An elevated anion gap with normal lactate and beta-hydroxybutyrate levels implies an alternative cause of the anion gap (e.g. certain intoxications).

• #70 Diabetic ketoacidosis diagnosis in a hospital setting – Journal of Osteopathic Medicine

  https://jom.osteopathic.org/abstract/diabetic-ketoacidosis-diagnosis-in-a-hospital-setting/

  Diabetic ketoacidosis (DKA) is an endocrine emergency that can occur in people with diabetes. Its incidence is estimated to be 220,340 hospital admissions each year. The misdiagnosis of DKA in the setting of hyperglycemic emergencies results in overtreatment and unnecessary increases in healthcare utilization and costs. […] A total of 520 hospital admissions were included for review. DKA was incorrectly diagnosed in 28.4% of the hospital admissions reviewed, based on a review of the labs and DKA diagnostic criteria. […] Almost one third of hospital admissions for hyperglycemic emergencies were misdiagnosed and managed as DKA. DKA diagnostic criteria are specific; however, other diagnoses like hyperosmolar hyperglycemic syndrome (HHS), hyperglycemia, and euglycemic DKA can make an accurate diagnosis more complicated. Education directed at improving the diagnostic accuracy of DKA among healthcare providers is needed to improve diagnostic accuracy, ensure the appropriate use of hospital resources, and potentially reduce costs to the healthcare system.

• #71 Diabetic ketoacidosis – Wikipedia

  https://en.wikipedia.org/wiki/Diabetic_ketoacidosis

  The American Diabetes Association categorizes DKA in adults into one of three stages of severity: Mild: blood pH mildly decreased to between 7.25 and 7.30 (normal 7.35-7.45); serum bicarbonate decreased to 15-18 mmol/L (normal above 20); the person is alert. […] Moderate: pH 7.00-7.25, bicarbonate 10-15, mild drowsiness may be present. […] Severe: pH below 7.00, bicarbonate below 10, stupor or coma may occur.

• #72 Diabetic Ketoacidosis

  https://fpnotebook.com/Endo/DM/DbtcKtcds.htm

  Mild DKA: 7.2 to 7.3 (some other guidelines list pH 7.25 to 7.30) […] Moderate DKA: 7.1 to 7.2 (some other guidelines list pH 7.2 to 7.25) […] Severe DKA: 7.1 (some other guidelines list pH 7.2) […] Serum bicarbonate […] Mild: 15-18 […] Moderate: 10 to 14 […] Severe: 10 […] Mental status […] Mild: Alert […] Moderate: Drowsy […] Severe: Stupor

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