Materiały źródłowe

• #1 Diabetic Ketoacidosis (DKA): Practice Essentials, Background, Pathophysiology

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

  Diabetic ketoacidosis (DKA) is an acute, major, life-threatening complication of diabetes characterized by hyperglycemia, ketoacidosis, and ketonuria. […] DKA mainly occurs in patients with type 1 diabetes, but it is not uncommon in some patients with type 2 diabetes (most likely latent autoimmune diabetes of adults [LADA] or Flatbush diabetes). […] The most common causes are underlying infection, disruption of insulin treatment, and new onset of diabetes. […] The most common scenarios for diabetic ketoacidosis (DKA) are underlying or concomitant infection (40%), missed or disrupted insulin treatments (25%), and newly diagnosed, previously unknown diabetes (15%). […] Causes of DKA in type 1 diabetes mellitus include the following: In 25% of patients, DKA is present at diagnosis of type 1 diabetes due to acute insulin deficiency (occurs in 25% of patients).

• #2 Ketoacidosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK534848/

  Ketoacidosis is a metabolic state associated with pathologically high serum and urine concentrations of ketone bodies. Clinically relevant forms of ketoacidoses include diabetic ketoacidosis (DKA), alcoholic ketoacidosis (AKA), and starvation ketoacidosis. DKA is a potentially life-threatening complication of uncontrolled diabetes. It typically occurs in the setting of hyperglycemia and insulin deficiency, which causes unopposed lipolysis and oxidation of free fatty acids and thereby results in ketone body production and a subsequent increased anion gap metabolic acidosis. […] DKA can occur in patients with diabetes mellitus, most frequently associated with relative insulin deficiency. This may be caused by precipitating physiologic stress or, in some cases, maybe the initial clinical presentation in patients with previously undiagnosed diabetes. Some of the more common risk factors that can precipitate the development of extreme hyperglycemia and subsequent ketoacidosis are infection, non-adherence to insulin therapy, acute major illnesses like myocardial infarction, sepsis, pancreatitis, stress, trauma, and the use of certain medications, such as glucocorticoids or atypical antipsychotic agents which have the potential to affect carbohydrate metabolism.

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

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

  Diabetic ketoacidosis (DKA) is caused by an overload of ketones present in your blood. […] When your cells don’t get the glucose they need for energy, your body begins to burn fat for energy, which produces ketones. […] High levels of ketones can poison the body. […] DKA may happen to anyone with diabetes, though it is rare in people with type 2. […] Here are three basic reasons for moderate or large amounts of ketones: Not enough insulin, Not enough food, Insulin reaction (low blood glucose).

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

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

  Diabetic ketoacidosis usually happens because your body doesn’t have enough insulin. Your cells can’t use the sugar in your blood for energy, so they use fat for fuel instead. Burning fat makes acids called ketones. If the process goes on for a while, they could build up in your blood. Having too many ketones can change the chemical balance of your blood and throw off your entire system. […] Certain things can make your blood sugar go up and your insulin go down, which makes your body more likely to start burning fat and building up ketones. These include: […] Missing insulin doses and diabetes mismanagement. If you miss doses of insulin or other medications a lot, or if your doctor prescribed the wrong dose, etc., your blood sugar might be further away from your target. You are at higher risk for DKA when your diabetes is not well-managed.

• #5 Diabetic Ketoacidosis – UF Health

  https://ufhealth.org/conditions-and-treatments/diabetic-ketoacidosis

  Diabetic ketoacidosis (DKA) is a life-threatening problem that affects people with diabetes. It occurs when the body starts breaking down fat at a rate that is much too fast. The liver processes the fat into a fuel called ketones, which causes the blood to become acidic. […] DKA happens when the signal from insulin in the body is so low that: Blood sugar (glucose) can’t go into cells to be used as a fuel source. The liver makes a large amount of glucose. Fat is broken down too rapidly for the body to process. […] DKA is sometimes the first sign of type 1 diabetes in people who have not yet been diagnosed. It can also occur in someone who has already been diagnosed with type 1 diabetes. Infection, injury, a serious illness, missing doses of insulin shots, or the stress of surgery can lead to DKA in people with type 1 diabetes. […] People with type 2 diabetes can also develop DKA, but it is much less common and less severe. It is usually triggered by prolonged uncontrolled blood sugar, missing doses of medicines, or a severe illness or infection.

• #6 Severe Diabetic Ketoacidosis in Children with Type 1 Diabetes: Ongoing Challenges in Care

  https://www.mdpi.com/2227-9067/12/1/110

  Despite advances in diabetes care and management, episodes of severe DKA are still associated with significant morbidity and mortality, emphasizing the importance of early recognition and prompt intervention. Challenges such as delayed diagnosis, comorbid conditions, and variability in clinical presentations can complicate the management and increase the risk of adverse outcomes. Enhanced efforts in diabetes prevention and education, improved access to care, and addressing socioeconomic disparities are essential in reducing the incidence and severity of DKA in children and adolescents. […] DKA arises from the progressive β-cell dysfunction in subjects with previously undiagnosed diabetes or from insulin omission, pump failure, or inadequate insulin administration in established diabetes during infections, surgery, trauma, or stress. In these conditions, insufficient insulin leads to uncontrolled hepatic glucose production by the liver and kidneys, impaired peripheral glucose uptake, and enhanced lipolysis, contributing to ketogenesis. This insulin deficiency mimics the pathophysiological mechanisms of hypoglycemia, triggering the release of counter-regulatory hormones (e.g., cortisol, glucagon, catecholamines, and growth hormone), which elevate serum glucose levels by reducing peripheral glucose use, promoting hepatic gluconeogenesis, and stimulating glycogenolysis. Additionally, hormone-sensitive lipase activity in adipose tissue increases, breaking down triglycerides into glycerol and elevating free fatty acid levels, converted into ketones, such as acetoacetate and β-hydroxybutyrate, through hepatic ketogenesis. Among these, β-hydroxybutyrate predominates and contributes significantly to the development of metabolic acidosis. Hyperglycemia also induces osmotic diuresis, leading to severe dehydration and electrolyte imbalances (e.g., hyponatremia, hypokalemia, hyperkalemia, hyperchloremia, hypophosphatemia, hypocalcemia and hypomagnesemia). Both hyperglycemia and elevated ketones levels worsen osmotic diuresis, resulting in hypovolemia and a reduced glomerular filtration rate, which further intensifies hyperglycemia. Furthermore, hyperglycemia, combined with ketoacidosis, triggers proinflammatory cytokines release and oxidative stress, further impairing insulin secretion and sensitivity. Finally, free fatty acids may inhibit nitric oxide production, leading to endothelial dysfunction.

• #7 Diabetic ketoacidosis – Etiology | BMJ Best Practice US

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

  In DKA, there is a reduction in the net effective concentration of circulating insulin along with an elevation of counter-regulatory hormones (glucagon, catecholamines, cortisol, and growth hormone). These alterations lead to extreme manifestations of metabolic derangements that can occur in diabetes. The two most common precipitating events are inadequate insulin therapy or infection. Underlying medical conditions such as myocardial infarction or stroke that provoke the release of counter-regulatory hormones are also likely to result in DKA in patients with diabetes. Drugs that affect carbohydrate metabolism, such as corticosteroids, thiazides, pentamidine, sympathomimetic agents (e.g., dobutamine and terbutaline), second-generation antipsychotic agents, and immune checkpoint inhibitors may contribute to the development of DKA. […] The use of sodium-glucose cotransporter 2 (SGLT-2) inhibitors has also been implicated in the development of euglycemic DKA in patients with both type 1 and type 2 diabetes.

• #8 Diabetic Ketoacidosis (DKA): Practice Essentials, Background, Pathophysiology

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

  Diabetic ketoacidosis (DKA) is an acute, major, life-threatening complication of diabetes characterized by hyperglycemia, ketoacidosis, and ketonuria. […] DKA mainly occurs in patients with type 1 diabetes, but it is not uncommon in some patients with type 2 diabetes (most likely latent autoimmune diabetes of adults [LADA] or Flatbush diabetes). […] The most common causes are underlying infection, disruption of insulin treatment, and new onset of diabetes. […] The most common scenarios for diabetic ketoacidosis (DKA) are underlying or concomitant infection (40%), missed or disrupted insulin treatments (25%), and newly diagnosed, previously unknown diabetes (15%). […] Causes of DKA in type 1 diabetes mellitus include the following: In 25% of patients, DKA is present at diagnosis of type 1 diabetes due to acute insulin deficiency (occurs in 25% of patients).

• #9

  https://journals.lww.com/annals-of-medicine-and-surgery/fulltext/2023/06000/comprehensive_review_of_diabetic_ketoacidosis__an.81.aspx

  The most frequent hyperglycemic emergency and the leading cause of death in people with diabetes mellitus is diabetic ketoacidosis (DKA). DKA is common in people with type 1 diabetes, while type 2 diabetes accounts for roughly one-third of occurrences. […] According to specific research, DKA can be present at the time of type 1 diabetes onset in 25 to 30% of cases and in 4 to 29% of young people with type 2 diabetes mellitus, and its features include hyperglycemia, metabolic acidosis, and ketosis with its triggering factors commonly being infections, newly discovered diabetes, and failure to start insulin therapy. […] Diabetic ketoacidosis is a grievous complication of diabetes that occurs when there is a lack of insulin in the body, resulting in elevated blood glucose levels and the production of ketones.

• #10 Diabetic Ketoacidosis (DKA): Practice Essentials, Background, Pathophysiology

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

  Diabetic ketoacidosis (DKA) is an acute, major, life-threatening complication of diabetes characterized by hyperglycemia, ketoacidosis, and ketonuria. […] DKA mainly occurs in patients with type 1 diabetes, but it is not uncommon in some patients with type 2 diabetes (most likely latent autoimmune diabetes of adults [LADA] or Flatbush diabetes). […] The most common causes are underlying infection, disruption of insulin treatment, and new onset of diabetes. […] The most common scenarios for diabetic ketoacidosis (DKA) are underlying or concomitant infection (40%), missed or disrupted insulin treatments (25%), and newly diagnosed, previously unknown diabetes (15%). […] Causes of DKA in type 1 diabetes mellitus include the following: In 25% of patients, DKA is present at diagnosis of type 1 diabetes due to acute insulin deficiency (occurs in 25% of patients).

• #11 Diabetic Ketoacidosis | Diabetes | CDC

  https://www.cdc.gov/diabetes/about/diabetic-ketoacidosis.html

  DKA develops when your body doesn’t have enough insulin to allow blood sugar into your cells for use as energy. […] Very high blood sugar and low insulin levels lead to DKA. The two most common causes are: […] Illness. You may not be able to eat or drink as much as usual, which can make blood sugar hard to manage. […] Missing insulin shots, a clogged insulin pump, or the wrong insulin dose. […] Other causes of DKA include: […] Heart attack or stroke. […] Physical injury, such as from a car accident. […] Alcohol or drug use. […] Certain medicines, such as some diuretics (water pills) and corticosteroids (used to treat inflammation in the body).

• #12 Pediatric Diabetic Ketoacidosis (DKA): Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/907111-overview

  In children with established diabetes, diabetic ketoacidosis may be due to insulin omission (intentional or unintentional), acute illness (such as infection or injury), or failure of the insulin-delivery device (such as insulin pump site failure). […] Failure to administer prescribed insulin is the most common cause of diabetic ketoacidosis in adolescents. […] Children on continuous subcutaneous insulin infusion are at particular risk for diabetic ketoacidosis if the device fails or if insulin delivery is disrupted, because they have no long-acting insulin on board and therefore become insulin deficient very quickly. […] Some children have repeated episodes of diabetic ketoacidosis. These patients may have emotional disturbances relating to home, school, or relationships with their peer group. […] Alcohol and drug abuse, particularly with cocaine, amphetamine derivatives, and their analogues, are other precipitants of diabetic ketoacidosis. […] In the developing world, infection and the lack of available insulin are the most important causes of diabetic ketoacidosis.

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

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

  Timing of diabetes diagnosis. People who dont know they are diabetic and people who just found out that they have diabetes are more likely to get DKA. This is probably because they dont have as much experience managing their diabetes. […] How you take your insulin. People who give themselves shots of insulin are more likely to get DKA than people who use an insulin pump. However, if you use an insulin pump and it gets clogged or stops working, youre at risk for DKA because your body wont get the amount of insulin you need until your pump gets fixed. […] Using expired insulin. If your insulin is spoiled or expired, it might not work as well as it should. […] Other things that could lead to DKA include: […] Being sick or stressed. When youre sick or under a lot of stress, your body makes more stress hormones, including adrenaline and cortisol. These hormones can get in the way of insulin and stop it from helping sugar get inside your cells.

• #14 Diabetic Ketoacidosis (DKA): Practice Essentials, Background, Pathophysiology

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

  Diabetic ketoacidosis (DKA) is an acute, major, life-threatening complication of diabetes characterized by hyperglycemia, ketoacidosis, and ketonuria. […] DKA mainly occurs in patients with type 1 diabetes, but it is not uncommon in some patients with type 2 diabetes (most likely latent autoimmune diabetes of adults [LADA] or Flatbush diabetes). […] The most common causes are underlying infection, disruption of insulin treatment, and new onset of diabetes. […] The most common scenarios for diabetic ketoacidosis (DKA) are underlying or concomitant infection (40%), missed or disrupted insulin treatments (25%), and newly diagnosed, previously unknown diabetes (15%). […] Causes of DKA in type 1 diabetes mellitus include the following: In 25% of patients, DKA is present at diagnosis of type 1 diabetes due to acute insulin deficiency (occurs in 25% of patients).

• #15

  https://journals.lww.com/annals-of-medicine-and-surgery/fulltext/2023/06000/comprehensive_review_of_diabetic_ketoacidosis__an.81.aspx

  The commonest precipitants of diabetic ketoacidosis are poor compliance with insulin therapy, infections, and a new diagnosis of diabetes. The most common precipitating factor of diabetic ketoacidosis in type 1 diabetes patients is nonadherence to treatment, while infections are the most common precipitant in type 2 diabetes patients.

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

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

  Infections. Common sicknesses that sometimes lead to DKA are urinary tract infections (also called UTIs or bladder infections) and pneumonia. […] Trauma to your body. Getting hurt or needing surgery also makes your body send out stress hormones that get in the way of insulin, which can lead to DKA. […] Heart attacks, strokes, and blood clots. These problems with your heart, lungs, and blood flow can all cause DKA. […] Pancreatitis (inflammation in your pancreas). This can lead to DKA, and it can also be a symptom of it. Many people with pancreatitis have bad stomach pain. […] Pregnancy. Being pregnant changes how your body processes sugars and other nutrients. Pregnant people who have diabetes are at higher risk of DKA. […] Alcohol, drugs, and certain medicines. Drinking alcohol and using drugs such as cocaine can put you at higher risk of DKA. Some medications, such as corticosteroids, water pills (diuretics), and those used to treat serious mental health conditions can also lead to DKA.

• #17 What Is Diabetic Ketoacidosis? Causes and Symptoms Explained | Dr. Berg

  https://www.drberg.com/blog/what-do-you-do-if-you-get-ketoacidosis

  Diabetic ketoacidosis is a potentially life-threatening condition that primarily affects individuals with type 1 diabetes and is typically caused by missed or incorrect insulin therapy. […] A study published in The Lancet found that most DKA cases are linked to missed insulin doses, insulin pump problems, or incorrect insulin dosage calculations. […] In addition, the body’s demand for insulin can be affected by stress and illness, making it difficult to assess accurate insulin requirements, increasing the risk of ketoacidosis in individuals with type 1 diabetes. […] Research published in Diagnostics investigated the link between infections and DKA and found that About 50 percent of cases of ketoacidosis result from bacterial infections like urinary tract infections (UTIs). […] Not only can a UTI interfere with the body’s insulin requirements, but it may also lead to dehydration, which reduces fluid levels and blood volume. This significantly increases the risk of ketoacidosis as low blood volume results in higher glucose and ketone concentrations in the bloodstream.

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

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

  Diabetic ketoacidosis usually happens after: […] An illness. An infection or other illness can cause the body to make higher levels of certain hormones, such as adrenaline or cortisol. These hormones work against the effects of insulin and sometimes cause diabetic ketoacidosis. Pneumonia and urinary tract infections are common illnesses that can lead to diabetic ketoacidosis. […] A problem with insulin therapy. Missed insulin treatments can leave too little insulin in the body. Not enough insulin therapy or an insulin pump that doesn’t work right also can leave too little insulin in the body. Any of these problems can lead to diabetic ketoacidosis. […] Other things that can lead to diabetic ketoacidosis include: Physical or emotional trauma, Heart attack or stroke, Pancreatitis, Pregnancy, Alcohol or drug misuse, particularly cocaine, Certain medicines, such as corticosteroids and some diuretics.

• #19 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) occurs in patients with type 1 diabetes mellitus and is less common in those with type 2 diabetes. It develops when insulin levels are insufficient to meet the body’s basic metabolic requirements. […] Common physiologic stresses that can trigger DKA include acute infection (eg, pneumonia, urinary tract infection, COVID-19), myocardial infarction, stroke, pancreatitis, pregnancy, trauma, and missed insulin doses. […] Some medications implicated in causing DKA include corticosteroids, thiazide diuretics, sympathomimetics, and sodium-glucose co-transporter 2 (SGLT-2) inhibitors. […] DKA is less common in type 2 diabetes mellitus, but it may occur in situations of unusual physiologic stress. […] SGLT-2 inhibitors have been implicated in causing DKA in both type 1 and type 2 diabetes. […] Euglycemic DKA can also occur with alcohol overuse or cirrhosis.

• #20 Ketoacidosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK534848/

  Ketoacidosis is a metabolic state associated with pathologically high serum and urine concentrations of ketone bodies. Clinically relevant forms of ketoacidoses include diabetic ketoacidosis (DKA), alcoholic ketoacidosis (AKA), and starvation ketoacidosis. DKA is a potentially life-threatening complication of uncontrolled diabetes. It typically occurs in the setting of hyperglycemia and insulin deficiency, which causes unopposed lipolysis and oxidation of free fatty acids and thereby results in ketone body production and a subsequent increased anion gap metabolic acidosis. […] DKA can occur in patients with diabetes mellitus, most frequently associated with relative insulin deficiency. This may be caused by precipitating physiologic stress or, in some cases, maybe the initial clinical presentation in patients with previously undiagnosed diabetes. Some of the more common risk factors that can precipitate the development of extreme hyperglycemia and subsequent ketoacidosis are infection, non-adherence to insulin therapy, acute major illnesses like myocardial infarction, sepsis, pancreatitis, stress, trauma, and the use of certain medications, such as glucocorticoids or atypical antipsychotic agents which have the potential to affect carbohydrate metabolism.

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

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

  Diabetic ketoacidosis usually happens after: […] An illness. An infection or other illness can cause the body to make higher levels of certain hormones, such as adrenaline or cortisol. These hormones work against the effects of insulin and sometimes cause diabetic ketoacidosis. Pneumonia and urinary tract infections are common illnesses that can lead to diabetic ketoacidosis. […] A problem with insulin therapy. Missed insulin treatments can leave too little insulin in the body. Not enough insulin therapy or an insulin pump that doesn’t work right also can leave too little insulin in the body. Any of these problems can lead to diabetic ketoacidosis. […] Other things that can lead to diabetic ketoacidosis include: Physical or emotional trauma, Heart attack or stroke, Pancreatitis, Pregnancy, Alcohol or drug misuse, particularly cocaine, Certain medicines, such as corticosteroids and some diuretics.

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

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

  Timing of diabetes diagnosis. People who dont know they are diabetic and people who just found out that they have diabetes are more likely to get DKA. This is probably because they dont have as much experience managing their diabetes. […] How you take your insulin. People who give themselves shots of insulin are more likely to get DKA than people who use an insulin pump. However, if you use an insulin pump and it gets clogged or stops working, youre at risk for DKA because your body wont get the amount of insulin you need until your pump gets fixed. […] Using expired insulin. If your insulin is spoiled or expired, it might not work as well as it should. […] Other things that could lead to DKA include: […] Being sick or stressed. When youre sick or under a lot of stress, your body makes more stress hormones, including adrenaline and cortisol. These hormones can get in the way of insulin and stop it from helping sugar get inside your cells.

• #23 Diabetic ketoacidosis – Etiology | BMJ Best Practice US

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

  In DKA, there is a reduction in the net effective concentration of circulating insulin along with an elevation of counter-regulatory hormones (glucagon, catecholamines, cortisol, and growth hormone). These alterations lead to extreme manifestations of metabolic derangements that can occur in diabetes. The two most common precipitating events are inadequate insulin therapy or infection. Underlying medical conditions such as myocardial infarction or stroke that provoke the release of counter-regulatory hormones are also likely to result in DKA in patients with diabetes. Drugs that affect carbohydrate metabolism, such as corticosteroids, thiazides, pentamidine, sympathomimetic agents (e.g., dobutamine and terbutaline), second-generation antipsychotic agents, and immune checkpoint inhibitors may contribute to the development of DKA. […] The use of sodium-glucose cotransporter 2 (SGLT-2) inhibitors has also been implicated in the development of euglycemic DKA in patients with both type 1 and type 2 diabetes.

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

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

  Diabetic ketoacidosis usually happens after: […] An illness. An infection or other illness can cause the body to make higher levels of certain hormones, such as adrenaline or cortisol. These hormones work against the effects of insulin and sometimes cause diabetic ketoacidosis. Pneumonia and urinary tract infections are common illnesses that can lead to diabetic ketoacidosis. […] A problem with insulin therapy. Missed insulin treatments can leave too little insulin in the body. Not enough insulin therapy or an insulin pump that doesn’t work right also can leave too little insulin in the body. Any of these problems can lead to diabetic ketoacidosis. […] Other things that can lead to diabetic ketoacidosis include: Physical or emotional trauma, Heart attack or stroke, Pancreatitis, Pregnancy, Alcohol or drug misuse, particularly cocaine, Certain medicines, such as corticosteroids and some diuretics.

• #25 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) occurs in patients with type 1 diabetes mellitus and is less common in those with type 2 diabetes. It develops when insulin levels are insufficient to meet the body’s basic metabolic requirements. […] Common physiologic stresses that can trigger DKA include acute infection (eg, pneumonia, urinary tract infection, COVID-19), myocardial infarction, stroke, pancreatitis, pregnancy, trauma, and missed insulin doses. […] Some medications implicated in causing DKA include corticosteroids, thiazide diuretics, sympathomimetics, and sodium-glucose co-transporter 2 (SGLT-2) inhibitors. […] DKA is less common in type 2 diabetes mellitus, but it may occur in situations of unusual physiologic stress. […] SGLT-2 inhibitors have been implicated in causing DKA in both type 1 and type 2 diabetes. […] Euglycemic DKA can also occur with alcohol overuse or cirrhosis.

• #26 Diabetic Ketoacidosis | Diabetes | CDC

  https://www.cdc.gov/diabetes/about/diabetic-ketoacidosis.html

  DKA develops when your body doesn’t have enough insulin to allow blood sugar into your cells for use as energy. […] Very high blood sugar and low insulin levels lead to DKA. The two most common causes are: […] Illness. You may not be able to eat or drink as much as usual, which can make blood sugar hard to manage. […] Missing insulin shots, a clogged insulin pump, or the wrong insulin dose. […] Other causes of DKA include: […] Heart attack or stroke. […] Physical injury, such as from a car accident. […] Alcohol or drug use. […] Certain medicines, such as some diuretics (water pills) and corticosteroids (used to treat inflammation in the body).

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

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

  Diabetic ketoacidosis usually happens after: […] An illness. An infection or other illness can cause the body to make higher levels of certain hormones, such as adrenaline or cortisol. These hormones work against the effects of insulin and sometimes cause diabetic ketoacidosis. Pneumonia and urinary tract infections are common illnesses that can lead to diabetic ketoacidosis. […] A problem with insulin therapy. Missed insulin treatments can leave too little insulin in the body. Not enough insulin therapy or an insulin pump that doesn’t work right also can leave too little insulin in the body. Any of these problems can lead to diabetic ketoacidosis. […] Other things that can lead to diabetic ketoacidosis include: Physical or emotional trauma, Heart attack or stroke, Pancreatitis, Pregnancy, Alcohol or drug misuse, particularly cocaine, Certain medicines, such as corticosteroids and some diuretics.

• #28 Adult Diabetic Ketoacidosis – StatPearls – NCBI Bookshelf

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

  Diabetic ketoacidosis more commonly occurs in patients with type 1 diabetes, though it can also occur in patients with type 2 diabetes. Patients with type 2 diabetes are also at risk. In both populations, catabolic stress of acute illness or injuries such as trauma, surgery, or infections may be a trigger. 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. Other conditions like alcohol abuse, trauma, pulmonary embolism, and myocardial infarction can also precipitate DKA. Drugs that affect carbohydrate metabolisms, such as corticosteroids, thiazides, sympathomimetic agents, and pentamidine, may precipitate DKA. Conventional, as well as atypical antipsychotic drugs, may also cause hyperglycemia and rarely DKA.

• #29 Diabetic Ketoacidosis | Diabetes | CDC

  https://www.cdc.gov/diabetes/about/diabetic-ketoacidosis.html

  DKA develops when your body doesn’t have enough insulin to allow blood sugar into your cells for use as energy. […] Very high blood sugar and low insulin levels lead to DKA. The two most common causes are: […] Illness. You may not be able to eat or drink as much as usual, which can make blood sugar hard to manage. […] Missing insulin shots, a clogged insulin pump, or the wrong insulin dose. […] Other causes of DKA include: […] Heart attack or stroke. […] Physical injury, such as from a car accident. […] Alcohol or drug use. […] Certain medicines, such as some diuretics (water pills) and corticosteroids (used to treat inflammation in the body).

• #30 Diabetic Ketoacidosis | DKA Causes, Complications & Treatment – Lesson | Study.com

  https://study.com/academy/lesson/diabetic-ketoacidosis-a-serious-complication.html

  Physical trauma- Being in a traumatic situation increases the release of hormones such as cortisol and adrenaline which increase blood glucose levels. In a person with diabetes, with insufficient insulin or reaction to insulin, this could lead to DKA. […] Alcohol use- Excessive and prolonged use of alcohol can result in alcoholic DKA due to the body being malnourished. […] Pregnancy- Excessive emesis can result in malnourishment, which can result in the excessive production of ketones due to using fats as the main energy source. […] Drugs- Some medications such as corticosteroids and oral antidiabetic agents can cause DKA. […] Even though DKA occurs for both types of diabetes, the highest risk factor is having type 1 diabetes. […] Diabetic ketoacidosis (DKA) occurs when the body uses fats as its main energy source (ketosis). […] As a result of this, excessive ketones are produced which cannot be excreted efficiently. […] Acidosis occurs when the blood pH is at 7.35 or lower. This is potentially life-threatening and can result in coma and or death.

• #31 Diabetic Ketoacidosis | LifeMD

  https://lifemd.com/learn/diabetic-ketoacidosis

  Diabetic ketoacidosis typically occurs when insulin levels are too low to allow glucose to enter cells for energy, causing the body to rely on fat breakdown as an alternative energy source. […] Common causes of DKA include missed insulin doses, infections, and severe physical or emotional stress, all of which can further reduce insulin availability or effectiveness. […] Other contributing factors include insulin pump malfunctions, certain medications, and consistently high blood sugar levels.

• #32 Diabetic ketoacidosis – Etiology | BMJ Best Practice US

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

  In DKA, there is a reduction in the net effective concentration of circulating insulin along with an elevation of counter-regulatory hormones (glucagon, catecholamines, cortisol, and growth hormone). These alterations lead to extreme manifestations of metabolic derangements that can occur in diabetes. The two most common precipitating events are inadequate insulin therapy or infection. Underlying medical conditions such as myocardial infarction or stroke that provoke the release of counter-regulatory hormones are also likely to result in DKA in patients with diabetes. Drugs that affect carbohydrate metabolism, such as corticosteroids, thiazides, pentamidine, sympathomimetic agents (e.g., dobutamine and terbutaline), second-generation antipsychotic agents, and immune checkpoint inhibitors may contribute to the development of DKA. […] The use of sodium-glucose cotransporter 2 (SGLT-2) inhibitors has also been implicated in the development of euglycemic DKA in patients with both type 1 and type 2 diabetes.

• #33 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) occurs in patients with type 1 diabetes mellitus and is less common in those with type 2 diabetes. It develops when insulin levels are insufficient to meet the body’s basic metabolic requirements. […] Common physiologic stresses that can trigger DKA include acute infection (eg, pneumonia, urinary tract infection, COVID-19), myocardial infarction, stroke, pancreatitis, pregnancy, trauma, and missed insulin doses. […] Some medications implicated in causing DKA include corticosteroids, thiazide diuretics, sympathomimetics, and sodium-glucose co-transporter 2 (SGLT-2) inhibitors. […] DKA is less common in type 2 diabetes mellitus, but it may occur in situations of unusual physiologic stress. […] SGLT-2 inhibitors have been implicated in causing DKA in both type 1 and type 2 diabetes. […] Euglycemic DKA can also occur with alcohol overuse or cirrhosis.

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

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

  Diabetic ketoacidosis usually happens after: […] An illness. An infection or other illness can cause the body to make higher levels of certain hormones, such as adrenaline or cortisol. These hormones work against the effects of insulin and sometimes cause diabetic ketoacidosis. Pneumonia and urinary tract infections are common illnesses that can lead to diabetic ketoacidosis. […] A problem with insulin therapy. Missed insulin treatments can leave too little insulin in the body. Not enough insulin therapy or an insulin pump that doesn’t work right also can leave too little insulin in the body. Any of these problems can lead to diabetic ketoacidosis. […] Other things that can lead to diabetic ketoacidosis include: Physical or emotional trauma, Heart attack or stroke, Pancreatitis, Pregnancy, Alcohol or drug misuse, particularly cocaine, Certain medicines, such as corticosteroids and some diuretics.

• #35 Diabetic Ketoacidosis – Causes, Symptoms, Treatment, Diagnosis – MedBroadcast.com

  https://medbroadcast.com/condition/getcondition/diabetic-ketoacidosis

  Some medications have been associated with increasing your risk of DKA, including steroids, thiazide diuretics (e.g., hydrochlorothiazide), sympathomimetics (e.g., amphetamine, pseudoephedrine), and a class of medications used in diabetes called SGLT2-inhibitors (e.g., canagliflozin, dapagliflozin, empagliflozin).

• #36 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) occurs in patients with type 1 diabetes mellitus and is less common in those with type 2 diabetes. It develops when insulin levels are insufficient to meet the body’s basic metabolic requirements. […] Common physiologic stresses that can trigger DKA include acute infection (eg, pneumonia, urinary tract infection, COVID-19), myocardial infarction, stroke, pancreatitis, pregnancy, trauma, and missed insulin doses. […] Some medications implicated in causing DKA include corticosteroids, thiazide diuretics, sympathomimetics, and sodium-glucose co-transporter 2 (SGLT-2) inhibitors. […] DKA is less common in type 2 diabetes mellitus, but it may occur in situations of unusual physiologic stress. […] SGLT-2 inhibitors have been implicated in causing DKA in both type 1 and type 2 diabetes. […] Euglycemic DKA can also occur with alcohol overuse or cirrhosis.

• #37 Diabetic ketoacidosis – Etiology | BMJ Best Practice US

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

  In DKA, there is a reduction in the net effective concentration of circulating insulin along with an elevation of counter-regulatory hormones (glucagon, catecholamines, cortisol, and growth hormone). These alterations lead to extreme manifestations of metabolic derangements that can occur in diabetes. The two most common precipitating events are inadequate insulin therapy or infection. Underlying medical conditions such as myocardial infarction or stroke that provoke the release of counter-regulatory hormones are also likely to result in DKA in patients with diabetes. Drugs that affect carbohydrate metabolism, such as corticosteroids, thiazides, pentamidine, sympathomimetic agents (e.g., dobutamine and terbutaline), second-generation antipsychotic agents, and immune checkpoint inhibitors may contribute to the development of DKA. […] The use of sodium-glucose cotransporter 2 (SGLT-2) inhibitors has also been implicated in the development of euglycemic DKA in patients with both type 1 and type 2 diabetes.

• #38 Adult Diabetic Ketoacidosis – StatPearls – NCBI Bookshelf

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

  SGLT2 inhibitors can predispose to diabetic ketoacidosis via multiple mechanisms. When SGLT2 inhibitors are used together with insulin, insulin doses are often decreased to avoid hypoglycemia. A lower dose of insulin may not be sufficient to suppress lipolysis and ketogenesis. SGLT2 is also expressed in pancreatic -cells. SGLT2 inhibitors promote glucagon secretion and may decrease urinary excretion of ketone bodies, leading to an increase in plasma ketone body levels as well as hyperglycemia and DKA. […] One of the major causes of recurrent DKA in the inner-city population in the United States is non-compliance with insulin. Socioeconomic and educational factors play a significant role in poor adhesion to medications, including insulin. A recent report suggests that cocaine abuse is an independent risk factor associated with DKA recurrence. […] Diabetic ketoacidosis (DKA) is one of the life-threatening but preventable complications of diabetes.

• #39 Diabetic ketoacidosis – Etiology | BMJ Best Practice US

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

  In DKA, there is a reduction in the net effective concentration of circulating insulin along with an elevation of counter-regulatory hormones (glucagon, catecholamines, cortisol, and growth hormone). These alterations lead to extreme manifestations of metabolic derangements that can occur in diabetes. The two most common precipitating events are inadequate insulin therapy or infection. Underlying medical conditions such as myocardial infarction or stroke that provoke the release of counter-regulatory hormones are also likely to result in DKA in patients with diabetes. Drugs that affect carbohydrate metabolism, such as corticosteroids, thiazides, pentamidine, sympathomimetic agents (e.g., dobutamine and terbutaline), second-generation antipsychotic agents, and immune checkpoint inhibitors may contribute to the development of DKA. […] The use of sodium-glucose cotransporter 2 (SGLT-2) inhibitors has also been implicated in the development of euglycemic DKA in patients with both type 1 and type 2 diabetes.

• #40 Adult Diabetic Ketoacidosis – StatPearls – NCBI Bookshelf

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

  Diabetic ketoacidosis more commonly occurs in patients with type 1 diabetes, though it can also occur in patients with type 2 diabetes. Patients with type 2 diabetes are also at risk. In both populations, catabolic stress of acute illness or injuries such as trauma, surgery, or infections may be a trigger. 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. Other conditions like alcohol abuse, trauma, pulmonary embolism, and myocardial infarction can also precipitate DKA. Drugs that affect carbohydrate metabolisms, such as corticosteroids, thiazides, sympathomimetic agents, and pentamidine, may precipitate DKA. Conventional, as well as atypical antipsychotic drugs, may also cause hyperglycemia and rarely DKA.

• #41 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) occurs in patients with type 1 diabetes mellitus and is less common in those with type 2 diabetes. It develops when insulin levels are insufficient to meet the body’s basic metabolic requirements. […] Common physiologic stresses that can trigger DKA include acute infection (eg, pneumonia, urinary tract infection, COVID-19), myocardial infarction, stroke, pancreatitis, pregnancy, trauma, and missed insulin doses. […] Some medications implicated in causing DKA include corticosteroids, thiazide diuretics, sympathomimetics, and sodium-glucose co-transporter 2 (SGLT-2) inhibitors. […] DKA is less common in type 2 diabetes mellitus, but it may occur in situations of unusual physiologic stress. […] SGLT-2 inhibitors have been implicated in causing DKA in both type 1 and type 2 diabetes. […] Euglycemic DKA can also occur with alcohol overuse or cirrhosis.

• #42 Diabetic ketoacidosis – Wikipedia

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

  Drugs in the gliflozin class (SGLT2 inhibitors), which are generally used for type 2 diabetes, have been associated with cases of diabetic ketoacidosis where the blood sugars may not be significantly elevated („euglycemic DKA”). […] Proposed mechanisms for SGLT2-I induced „euglycemic DKA” include increased ketosis due to volume depletion combined with relative insulin deficiency and glucagon excess.

• #43 Diabetic ketoacidosis – Etiology | BMJ Best Practice US

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

  In DKA, there is a reduction in the net effective concentration of circulating insulin along with an elevation of counter-regulatory hormones (glucagon, catecholamines, cortisol, and growth hormone). These alterations lead to extreme manifestations of metabolic derangements that can occur in diabetes. The two most common precipitating events are inadequate insulin therapy or infection. Underlying medical conditions such as myocardial infarction or stroke that provoke the release of counter-regulatory hormones are also likely to result in DKA in patients with diabetes. Drugs that affect carbohydrate metabolism, such as corticosteroids, thiazides, pentamidine, sympathomimetic agents (e.g., dobutamine and terbutaline), second-generation antipsychotic agents, and immune checkpoint inhibitors may contribute to the development of DKA. […] The use of sodium-glucose cotransporter 2 (SGLT-2) inhibitors has also been implicated in the development of euglycemic DKA in patients with both type 1 and type 2 diabetes.

• #44 Severe Diabetic Ketoacidosis in Children with Type 1 Diabetes: Ongoing Challenges in Care

  https://www.mdpi.com/2227-9067/12/1/110

  Different risk factors may contribute to the occurrence of severe DKA. These include drugs affecting carbohydrate metabolism, such as thiazides, corticosteroids, sympathomimetics (e.g., dobutamine, terbutaline), and atypical antipsychotics, which may precipitate DKA in susceptible individuals. Socioeconomic factors, including low income, area-level deprivation, homelessness, and lack of health insurance, are strongly associated with increased DKA risk. Other contributors include physiological conditions like pregnancy, where DKA may develop at lower glucose concentrations and present with nonspecific symptoms, such as nausea and vomiting. Females have a higher risk for DKA-related hospital admissions and recurrent episodes, potentially due to suboptimal glucose control, body image concerns, and higher prevalence of mental health issues. Additionally, oncological treatments, such as immune checkpoint inhibitors used in cancer therapy, have been linked to an increased risk of DKA.

• #45 Euglycemic diabetic ketoacidosis: a potential pitfall for the emergency physician

  https://www.ceemjournal.org/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 mechanisms involved in this metabolic disturbance are due to absolute or relative insulin deficiency. […] It is believed that eu-DKA primarily occurs due to a carbohydrate deficit, which leads to increased lipolytic activity and subsequent ketoacidosis. […] The causes of eu-DKA can be divided into two main groups: glucose wasting (due to such events as glucosuria or persistent vomiting) and low level of hepatic glycogen (due to such events as starvation and chronic alcoholism). […] Chronic alcohol consumption causes insulin resistance and destroys pancreatic beta cells. […] Maternal hormones, such as human placental lactogen and increased level of cortisol, contribute to increased insulin resistance in the pregnant patient.

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

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

  Infections. Common sicknesses that sometimes lead to DKA are urinary tract infections (also called UTIs or bladder infections) and pneumonia. […] Trauma to your body. Getting hurt or needing surgery also makes your body send out stress hormones that get in the way of insulin, which can lead to DKA. […] Heart attacks, strokes, and blood clots. These problems with your heart, lungs, and blood flow can all cause DKA. […] Pancreatitis (inflammation in your pancreas). This can lead to DKA, and it can also be a symptom of it. Many people with pancreatitis have bad stomach pain. […] Pregnancy. Being pregnant changes how your body processes sugars and other nutrients. Pregnant people who have diabetes are at higher risk of DKA. […] Alcohol, drugs, and certain medicines. Drinking alcohol and using drugs such as cocaine can put you at higher risk of DKA. Some medications, such as corticosteroids, water pills (diuretics), and those used to treat serious mental health conditions can also lead to DKA.

• #47 Adult Diabetic Ketoacidosis – StatPearls – NCBI Bookshelf

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

  SGLT2 inhibitors can predispose to diabetic ketoacidosis via multiple mechanisms. When SGLT2 inhibitors are used together with insulin, insulin doses are often decreased to avoid hypoglycemia. A lower dose of insulin may not be sufficient to suppress lipolysis and ketogenesis. SGLT2 is also expressed in pancreatic -cells. SGLT2 inhibitors promote glucagon secretion and may decrease urinary excretion of ketone bodies, leading to an increase in plasma ketone body levels as well as hyperglycemia and DKA. […] One of the major causes of recurrent DKA in the inner-city population in the United States is non-compliance with insulin. Socioeconomic and educational factors play a significant role in poor adhesion to medications, including insulin. A recent report suggests that cocaine abuse is an independent risk factor associated with DKA recurrence. […] Diabetic ketoacidosis (DKA) is one of the life-threatening but preventable complications of diabetes.

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

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

  Diabetic ketoacidosis usually happens after: […] An illness. An infection or other illness can cause the body to make higher levels of certain hormones, such as adrenaline or cortisol. These hormones work against the effects of insulin and sometimes cause diabetic ketoacidosis. Pneumonia and urinary tract infections are common illnesses that can lead to diabetic ketoacidosis. […] A problem with insulin therapy. Missed insulin treatments can leave too little insulin in the body. Not enough insulin therapy or an insulin pump that doesn’t work right also can leave too little insulin in the body. Any of these problems can lead to diabetic ketoacidosis. […] Other things that can lead to diabetic ketoacidosis include: Physical or emotional trauma, Heart attack or stroke, Pancreatitis, Pregnancy, Alcohol or drug misuse, particularly cocaine, Certain medicines, such as corticosteroids and some diuretics.

• #49 Pediatric Diabetic Ketoacidosis (DKA): Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/907111-overview

  In children with established diabetes, diabetic ketoacidosis may be due to insulin omission (intentional or unintentional), acute illness (such as infection or injury), or failure of the insulin-delivery device (such as insulin pump site failure). […] Failure to administer prescribed insulin is the most common cause of diabetic ketoacidosis in adolescents. […] Children on continuous subcutaneous insulin infusion are at particular risk for diabetic ketoacidosis if the device fails or if insulin delivery is disrupted, because they have no long-acting insulin on board and therefore become insulin deficient very quickly. […] Some children have repeated episodes of diabetic ketoacidosis. These patients may have emotional disturbances relating to home, school, or relationships with their peer group. […] Alcohol and drug abuse, particularly with cocaine, amphetamine derivatives, and their analogues, are other precipitants of diabetic ketoacidosis. […] In the developing world, infection and the lack of available insulin are the most important causes of diabetic ketoacidosis.

• #50 Diabetic Ketoacidosis (DKA): Practice Essentials, Background, Pathophysiology

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

  Causes of DKA in type 2 diabetes mellitus include the following: Intercurrent illness (eg, myocardial infarction, pneumonia, prostatitis, UTI). […] DKA has also been reported in people with type 2 diabetes treated with sodium-glucose cotransporter-2 (SGLT2) inhibitors. […] DKA also occurs in pregnant women, either with preexisting diabetes or with diabetes diagnosed during pregnancy. […] There is evidence that coronavirus disease 2019 (COVID-19) increases the risk of DKA, possibly in association with beta-cell destruction that may result from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19.

• #51 Euglycemic diabetic ketoacidosis: a potential pitfall for the emergency physician

  https://www.ceemjournal.org/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 mechanisms involved in this metabolic disturbance are due to absolute or relative insulin deficiency. […] It is believed that eu-DKA primarily occurs due to a carbohydrate deficit, which leads to increased lipolytic activity and subsequent ketoacidosis. […] The causes of eu-DKA can be divided into two main groups: glucose wasting (due to such events as glucosuria or persistent vomiting) and low level of hepatic glycogen (due to such events as starvation and chronic alcoholism). […] Chronic alcohol consumption causes insulin resistance and destroys pancreatic beta cells. […] Maternal hormones, such as human placental lactogen and increased level of cortisol, contribute to increased insulin resistance in the pregnant patient.

• #52 Diabetic ketoacidosis (DKA) | Ketosis symptoms and treatment | Diabetes UK

  https://www.diabetes.org.uk/about-diabetes/looking-after-diabetes/complications/diabetic-ketoacidosis

  Diabetic ketoacidosis, known as DKA, is a life-threatening diabetes complication. It is caused by a severe lack of insulin. Without insulin your body cant move sugar into the cells for energy so instead breaks down fat releasing harmful chemicals called ketones which build up and make your blood acidic. […] DKA is more likely to happen to someone with type 1 diabetes, someone with any type who uses insulin, and people taking SGLT2 inhibitors, but can happen to other people on tablets or without a diagnosis too. […] If you have already been diagnosed with diabetes, the causes of DKA can include: being ill, for example with a chest infection, flu, or Urinary Tract Infection (UTI); high blood sugar levels caused by a growth spurt or puberty; not taking your insulin or missing doses; your insulin pump not working properly or becoming accidentally dislodged; surgery or an injury; having a heart attack or stroke; high blood sugar caused by having your period.

• #53 Diabetic ketoacidosis (DKA) | Ketosis symptoms and treatment | Diabetes UK

  https://www.diabetes.org.uk/about-diabetes/looking-after-diabetes/complications/diabetic-ketoacidosis

  Diabetic ketoacidosis, known as DKA, is a life-threatening diabetes complication. It is caused by a severe lack of insulin. Without insulin your body cant move sugar into the cells for energy so instead breaks down fat releasing harmful chemicals called ketones which build up and make your blood acidic. […] DKA is more likely to happen to someone with type 1 diabetes, someone with any type who uses insulin, and people taking SGLT2 inhibitors, but can happen to other people on tablets or without a diagnosis too. […] If you have already been diagnosed with diabetes, the causes of DKA can include: being ill, for example with a chest infection, flu, or Urinary Tract Infection (UTI); high blood sugar levels caused by a growth spurt or puberty; not taking your insulin or missing doses; your insulin pump not working properly or becoming accidentally dislodged; surgery or an injury; having a heart attack or stroke; high blood sugar caused by having your period.

• #54 Diabetic Ketoacidosis: Symptoms and Treatment | Doctor

  https://patient.info/doctor/diabetic-ketoacidosis

  Diabetic ketoacidosis (DKA) is a medical emergency with a significant morbidity and mortality. […] DKA is normally seen in people with type 1 diabetes. […] However, DKA may also occur in people with type 2 diabetes, although people with type 2 diabetes are much more likely to have a hyperosmolar hyperglycaemic state. […] There may be no obvious precipitating factor but possible factors include: Infection, Discontinuation of insulin (unintentional or deliberate), Inadequate insulin, Cardiovascular disease – eg, stroke or myocardial infarction, Drug treatments – medication (notably corticosteroids, sympathomimetics, alpha-blockers, beta-blockers and diuretics and sodium-glucose co-transporter 2 (SGLT2) inhibitors) may provoke an episode of DKA, Any physiological stress (including pregnancy, trauma or surgery) has the potential to initiate DKA. […] Some women are more likely to go into DKA at the time of menstruation.

• #55 Hospital-Acquired Diabetic Ketoacidosis. | PSNet

  https://psnet.ahrq.gov/web-mm/hospital-acquired-diabetic-ketoacidosis

  In the first case, a patient with type 1 diabetes and ESRD presented to the ED with hypertensive urgency, which was treated appropriately. However, his transfer back to the SNF where he lived was delayed, and the ED staff (having officially discharged the patient) failed to attend to his need for basal insulin, allowing him to develop diabetic ketoacidosis (DKA). […] In the second case, a patient with type 1 diabetes, homelessness, and inconsistent access to food and housing, presented to the ED with a thumb infection and hyperglycemia. Basal insulin was withheld, presumably because of his poor oral intake and unknown outpatient dosing, allowing this patient also to develop DKA within an acute care hospital. […] Several factors can contribute to the development or recurrence of DKA, including housing and food insecurity, substance use, low health literacy, chronically poor glucose control with a hemoglobin A1c (A1c) of 8.5% or greater, psychiatric disorders such as depression, and a history of non-adherence to insulin, for either economic or behavioral reasons.

• #56 Severe Diabetic Ketoacidosis in Children with Type 1 Diabetes: Ongoing Challenges in Care

  https://www.mdpi.com/2227-9067/12/1/110

  Different risk factors may contribute to the occurrence of severe DKA. These include drugs affecting carbohydrate metabolism, such as thiazides, corticosteroids, sympathomimetics (e.g., dobutamine, terbutaline), and atypical antipsychotics, which may precipitate DKA in susceptible individuals. Socioeconomic factors, including low income, area-level deprivation, homelessness, and lack of health insurance, are strongly associated with increased DKA risk. Other contributors include physiological conditions like pregnancy, where DKA may develop at lower glucose concentrations and present with nonspecific symptoms, such as nausea and vomiting. Females have a higher risk for DKA-related hospital admissions and recurrent episodes, potentially due to suboptimal glucose control, body image concerns, and higher prevalence of mental health issues. Additionally, oncological treatments, such as immune checkpoint inhibitors used in cancer therapy, have been linked to an increased risk of DKA.

• #57 Euglycemic diabetic ketoacidosis: a potential pitfall for the emergency physician

  https://www.ceemjournal.org/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 mechanisms involved in this metabolic disturbance are due to absolute or relative insulin deficiency. […] It is believed that eu-DKA primarily occurs due to a carbohydrate deficit, which leads to increased lipolytic activity and subsequent ketoacidosis. […] The causes of eu-DKA can be divided into two main groups: glucose wasting (due to such events as glucosuria or persistent vomiting) and low level of hepatic glycogen (due to such events as starvation and chronic alcoholism). […] Chronic alcohol consumption causes insulin resistance and destroys pancreatic beta cells. […] Maternal hormones, such as human placental lactogen and increased level of cortisol, contribute to increased insulin resistance in the pregnant patient.

• #58 Euglycemic diabetic ketoacidosis: a potential pitfall for the emergency physician

  https://www.ceemjournal.org/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 mechanisms involved in this metabolic disturbance are due to absolute or relative insulin deficiency. […] It is believed that eu-DKA primarily occurs due to a carbohydrate deficit, which leads to increased lipolytic activity and subsequent ketoacidosis. […] The causes of eu-DKA can be divided into two main groups: glucose wasting (due to such events as glucosuria or persistent vomiting) and low level of hepatic glycogen (due to such events as starvation and chronic alcoholism). […] Chronic alcohol consumption causes insulin resistance and destroys pancreatic beta cells. […] Maternal hormones, such as human placental lactogen and increased level of cortisol, contribute to increased insulin resistance in the pregnant patient.

• #59 Euglycemic diabetic ketoacidosis: a potential pitfall for the emergency physician

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

  The year 2011 saw the introduction of sodium glucose transporter 2 (SGLT2) inhibitors, a class of drugs that includes dapagliflozin and canagliflozin, used in the management of patients with type 2 diabetes. […] However, since their launch, there have been several published case reports describing eu-DKA in patients treated with this class of drugs. […] The incidence of eu-DKA in patients with type 2 diabetes taking SGLT2 inhibitors is reported to be approximately 0.1%. […] Intercurrent illness, prolonged vomiting, chronic alcoholism, and SLGT2 inhibitors must be considered as potential triggers for eu-DKA in patients presenting with acidosis and an increased euglycemic anion gap, remembering that pregnant women and the malnourished are especially at risk.

• #60 Euglycemic diabetic ketoacidosis: a potential pitfall for the emergency physician

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

  The year 2011 saw the introduction of sodium glucose transporter 2 (SGLT2) inhibitors, a class of drugs that includes dapagliflozin and canagliflozin, used in the management of patients with type 2 diabetes. […] However, since their launch, there have been several published case reports describing eu-DKA in patients treated with this class of drugs. […] The incidence of eu-DKA in patients with type 2 diabetes taking SGLT2 inhibitors is reported to be approximately 0.1%. […] Intercurrent illness, prolonged vomiting, chronic alcoholism, and SLGT2 inhibitors must be considered as potential triggers for eu-DKA in patients presenting with acidosis and an increased euglycemic anion gap, remembering that pregnant women and the malnourished are especially at risk.

• #61 Diabetic Ketoacidosis: Types, Symptoms, Causes, Diagnosis, Treatment and More

  https://www.health.com/diabetic-ketoacidosis-overview-7373594

  Diabetic ketoacidosis results when you dont have enough insulin in your body. […] Having diabetes can make you more vulnerable to diabetic ketoacidosis, especially in one of the following circumstances: Infection or illness, such as pneumonia, urinary tract infection (UTI), or COVID-19; New diabetes diagnosis; Not following your insulin therapy plan; Malfunction of an insulin pump or insulin delivery device. […] If you take sodium-glucose co-transporter 2 (SGLT2) inhibitors, you may also be at greater risk for euglycemic diabetic ketoacidosis. Other potential causes for euglycemic ketoacidosis include pregnancy and prolonged fasting.

• #62 Diabetic Ketoacidosis (DKA): Practice Essentials, Background, Pathophysiology

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

  Diabetic ketoacidosis (DKA) is an acute, major, life-threatening complication of diabetes characterized by hyperglycemia, ketoacidosis, and ketonuria. […] DKA mainly occurs in patients with type 1 diabetes, but it is not uncommon in some patients with type 2 diabetes (most likely latent autoimmune diabetes of adults [LADA] or Flatbush diabetes). […] The most common causes are underlying infection, disruption of insulin treatment, and new onset of diabetes. […] The most common scenarios for diabetic ketoacidosis (DKA) are underlying or concomitant infection (40%), missed or disrupted insulin treatments (25%), and newly diagnosed, previously unknown diabetes (15%). […] Causes of DKA in type 1 diabetes mellitus include the following: In 25% of patients, DKA is present at diagnosis of type 1 diabetes due to acute insulin deficiency (occurs in 25% of patients).

• #63 Diabetic Ketoacidosis – UF Health

  https://ufhealth.org/conditions-and-treatments/diabetic-ketoacidosis

  Diabetic ketoacidosis (DKA) is a life-threatening problem that affects people with diabetes. It occurs when the body starts breaking down fat at a rate that is much too fast. The liver processes the fat into a fuel called ketones, which causes the blood to become acidic. […] DKA happens when the signal from insulin in the body is so low that: Blood sugar (glucose) can’t go into cells to be used as a fuel source. The liver makes a large amount of glucose. Fat is broken down too rapidly for the body to process. […] DKA is sometimes the first sign of type 1 diabetes in people who have not yet been diagnosed. It can also occur in someone who has already been diagnosed with type 1 diabetes. Infection, injury, a serious illness, missing doses of insulin shots, or the stress of surgery can lead to DKA in people with type 1 diabetes. […] People with type 2 diabetes can also develop DKA, but it is much less common and less severe. It is usually triggered by prolonged uncontrolled blood sugar, missing doses of medicines, or a severe illness or infection.

• #64 Diabetic Ketoacidosis (DKA): Practice Essentials, Background, Pathophysiology

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

  Diabetic ketoacidosis (DKA) is an acute, major, life-threatening complication of diabetes characterized by hyperglycemia, ketoacidosis, and ketonuria. […] DKA mainly occurs in patients with type 1 diabetes, but it is not uncommon in some patients with type 2 diabetes (most likely latent autoimmune diabetes of adults [LADA] or Flatbush diabetes). […] The most common causes are underlying infection, disruption of insulin treatment, and new onset of diabetes. […] The most common scenarios for diabetic ketoacidosis (DKA) are underlying or concomitant infection (40%), missed or disrupted insulin treatments (25%), and newly diagnosed, previously unknown diabetes (15%). […] Causes of DKA in type 1 diabetes mellitus include the following: In 25% of patients, DKA is present at diagnosis of type 1 diabetes due to acute insulin deficiency (occurs in 25% of patients).

• #65 Pediatric Diabetic Ketoacidosis (DKA): Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/907111-overview

  In children with established diabetes, diabetic ketoacidosis may be due to insulin omission (intentional or unintentional), acute illness (such as infection or injury), or failure of the insulin-delivery device (such as insulin pump site failure). […] Failure to administer prescribed insulin is the most common cause of diabetic ketoacidosis in adolescents. […] Children on continuous subcutaneous insulin infusion are at particular risk for diabetic ketoacidosis if the device fails or if insulin delivery is disrupted, because they have no long-acting insulin on board and therefore become insulin deficient very quickly. […] Some children have repeated episodes of diabetic ketoacidosis. These patients may have emotional disturbances relating to home, school, or relationships with their peer group. […] Alcohol and drug abuse, particularly with cocaine, amphetamine derivatives, and their analogues, are other precipitants of diabetic ketoacidosis. […] In the developing world, infection and the lack of available insulin are the most important causes of diabetic ketoacidosis.

• #66 Diabetic Ketoacidosis | Diabetes Teaching Center

  https://diabetesteachingcenter.ucsf.edu/living-diabetes/acute-complications/diabetic-ketoacidosis

  Diabetic Ketoacidosis (DKA) a condition brought on by inadequate insulin – is a life-threatening emergency usually affecting people with Type 1 Diabetes. Although less common, it also can happen when you have Type 2 Diabetes. […] A lack of insulin usually due to: Unknown or newly diagnosed cases of Type 1 Diabetes, Missed or inadequate doses of insulin, or spoiled insulin, Infection, Steroid medications, An extremely stressful medical condition. […] DKA is rare in Type 2 Diabetes but can develop if someone with Type 2 Diabetes gets another serious medical condition. Examples of medical conditions associated with DKA in Type 2 Diabetes are severe infections, acute pancreatitis (inflammation of the insulin producing organ, the pancreas), and treatment with steroids.

• #67 Diabetic Ketoacidosis (DKA): Practice Essentials, Background, Pathophysiology

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

  Causes of DKA in type 2 diabetes mellitus include the following: Intercurrent illness (eg, myocardial infarction, pneumonia, prostatitis, UTI). […] DKA has also been reported in people with type 2 diabetes treated with sodium-glucose cotransporter-2 (SGLT2) inhibitors. […] DKA also occurs in pregnant women, either with preexisting diabetes or with diabetes diagnosed during pregnancy. […] There is evidence that coronavirus disease 2019 (COVID-19) increases the risk of DKA, possibly in association with beta-cell destruction that may result from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19.

• #68 Diabetic Ketoacidosis | Diabetes Teaching Center

  https://diabetesteachingcenter.ucsf.edu/living-diabetes/acute-complications/diabetic-ketoacidosis

  Diabetic Ketoacidosis (DKA) a condition brought on by inadequate insulin – is a life-threatening emergency usually affecting people with Type 1 Diabetes. Although less common, it also can happen when you have Type 2 Diabetes. […] A lack of insulin usually due to: Unknown or newly diagnosed cases of Type 1 Diabetes, Missed or inadequate doses of insulin, or spoiled insulin, Infection, Steroid medications, An extremely stressful medical condition. […] DKA is rare in Type 2 Diabetes but can develop if someone with Type 2 Diabetes gets another serious medical condition. Examples of medical conditions associated with DKA in Type 2 Diabetes are severe infections, acute pancreatitis (inflammation of the insulin producing organ, the pancreas), and treatment with steroids.

• #69 Diabetic Ketoacidosis | Diabetes Teaching Center

  https://diabetesteachingcenter.ucsf.edu/living-diabetes/acute-complications/diabetic-ketoacidosis

  Diabetic Ketoacidosis (DKA) a condition brought on by inadequate insulin – is a life-threatening emergency usually affecting people with Type 1 Diabetes. Although less common, it also can happen when you have Type 2 Diabetes. […] A lack of insulin usually due to: Unknown or newly diagnosed cases of Type 1 Diabetes, Missed or inadequate doses of insulin, or spoiled insulin, Infection, Steroid medications, An extremely stressful medical condition. […] DKA is rare in Type 2 Diabetes but can develop if someone with Type 2 Diabetes gets another serious medical condition. Examples of medical conditions associated with DKA in Type 2 Diabetes are severe infections, acute pancreatitis (inflammation of the insulin producing organ, the pancreas), and treatment with steroids.

• #70 Diabetic Ketoacidosis (DKA): Practice Essentials, Background, Pathophysiology

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

  Causes of DKA in type 2 diabetes mellitus include the following: Intercurrent illness (eg, myocardial infarction, pneumonia, prostatitis, UTI). […] DKA has also been reported in people with type 2 diabetes treated with sodium-glucose cotransporter-2 (SGLT2) inhibitors. […] DKA also occurs in pregnant women, either with preexisting diabetes or with diabetes diagnosed during pregnancy. […] There is evidence that coronavirus disease 2019 (COVID-19) increases the risk of DKA, possibly in association with beta-cell destruction that may result from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19.

• #71 Diabetic Ketoacidosis – Hormonal and Metabolic Disorders – MSD Manual Consumer Version

  https://www.msdmanuals.com/home/hormonal-and-metabolic-disorders/diabetes-mellitus-dm-and-disorders-of-blood-sugar-metabolism/diabetic-ketoacidosis

  Some people with type 2 diabetes are prone to develop ketoacidosis. This type of diabetes is called ketosis-prone diabetes, but is sometimes referred to as Flatbush diabetes. This type of diabetes is an unusual variant that is more likely to occur in people with obesity and in people of African ancestry.

• #72 Diabetic ketoacidosis – Wikipedia

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

  Diabetic ketoacidosis may occur in those previously known to have diabetes mellitus type 2 or in those who on further investigations turn out to have features of type 2 diabetes (e.g. obesity, strong family history); this is more common in African, African-American and Hispanic people. […] DKA results from a shortage of insulin; in response, the body switches to burning fatty acids, which produces acidic ketone bodies. […] Triggers may include infection, not taking insulin correctly, stroke and certain medications such as steroids. […] There is often a particular underlying problem that has led to the DKA episode; this may be intercurrent illness (pneumonia, influenza, gastroenteritis, a urinary tract infection), pregnancy, inadequate insulin administration (e.g. defective insulin pen device), myocardial infarction (heart attack), stroke or the use of cocaine.

• #73 Diabetic Ketoacidosis (DKA): Practice Essentials, Background, Pathophysiology

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

  Causes of DKA in type 2 diabetes mellitus include the following: Intercurrent illness (eg, myocardial infarction, pneumonia, prostatitis, UTI). […] DKA has also been reported in people with type 2 diabetes treated with sodium-glucose cotransporter-2 (SGLT2) inhibitors. […] DKA also occurs in pregnant women, either with preexisting diabetes or with diabetes diagnosed during pregnancy. […] There is evidence that coronavirus disease 2019 (COVID-19) increases the risk of DKA, possibly in association with beta-cell destruction that may result from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19.

• #74

  https://journals.lww.com/annals-of-medicine-and-surgery/fulltext/2023/06000/comprehensive_review_of_diabetic_ketoacidosis__an.81.aspx

  The commonest precipitants of diabetic ketoacidosis are poor compliance with insulin therapy, infections, and a new diagnosis of diabetes. The most common precipitating factor of diabetic ketoacidosis in type 1 diabetes patients is nonadherence to treatment, while infections are the most common precipitant in type 2 diabetes patients.

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