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Diabetic Ketoacidosis

Hyperglycemia can lead to a metabolic complication known as Diabetic Ketoacidosis (DKA).  It is a life-threatening but reversible complication, cause due to insulin deficiency and characterized by the severe disturbance in carbohydrate, protein and fat metabolism. DKA is commonly seen in Type 1 diabetes, however, it can also occur in the patient with type 2 diabetes.

Due to inadequate insulin for glucose use body depends on proteins, fats, and glycogen for energy. A decrease in glucose uptake triggers hyperglycaemia and increased gluconeogenesis  (energy production from non-carbohydrate sources, such as protein, fat, and glycogen). Glucosuria results in osmotic diuresis causing dehydration and acidosis. There is an increase in enzyme lipase activity leading to the breakdown of adipose tissue  (fats) resulting into the excessive production of ketones.  Ketones are spill into the urine, hence the reliance on testing for ketones.  Thus, DKA is a triad of hyperglycemia, ketosis, and acidosis.


  • Clinical signs and symptoms
  • Blood glucose level- Greater than 250 mg/dl but generally less than 600 mg/dl, presence ketones in the  Urine ( Moderate to large) and  Blood  (>3mmol/L), pH less than 7.3, serum bicarbonate level less than 18 mEq/L and dehydration.
  • Symptoms :
  • Polyuria (Increased urination)
  • Polydipsia (Increased thirst)
  • Hyperventilation
  • Fatigue
  • Muscle cramps
  • Tiredness
  • Fruity odour of ketones




  • Precipitating factors:
  • Acute illness such as colds, flu, vomiting, and diarrhoea, if not managed properly can lead to the development of DKA.
  • Discontinuation of or inadequate insulin
  • Myocardial infarction, Stroke
  • Pancreatitis
  • Medications such as corticosteroids


  • Management


  • Requires hospitalisation
  • Supplemental insulin for lowering blood glucose level
  • Fluid and electrolyte replacement to correct dehydration and acidosis.



Written by: Madiha Khan



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  • Tel: +91 - 9930078797
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