Diabetic ketoacidosis

Diabetic ketoacidosis (DKA) is medical emergency. All metabolic disturbances seen in DKA are the indirect or direct consequences of the lack of insulin. This is severe uncontrolled diabetes which requiring emergency treatment with insulin and intravenous fluids.

If the diabetic patient has insufficient insulin effect to block the mobilization and metabolism of free fatty acids, the metabolic byproducts acetoacetate and β –hdroxybutyrate accumulate.

Ketone bodies: 3-hydroxybutyrate, acetoacetate, acetone

These ketone bodies are organic acids and cause a metabolic acidosis with an increased unmeasured anion gap.

In this case, DKA may be defined as a blood glucose level usually greater than 250 mg/DL, pH less that 7.2 or 7.3 and plasma bicarbonate level of 15 or less. Severe DKA is defined as a pH of 7.1 or less and a bicarbonate level of 10 or less.

The most common precipitating factors in the development of DKA are infection, myocardial infarction, trauma or omission of insulin.
Diabetic ketoacidosis