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Diabetic ketoacidosis

Y. Glick,Jonathan Bong

Published 2018 in Radiopaedia.org

ABSTRACT

bolic complication mostly attributed to type 1 diabetes mellitus and in some cases to type 2 diabetes mellitus, as well as to gestational diabetes. DKA was first described in 1886 and, until the introduction of insulin therapy in the 1920s, it was almost universally fatal. DKA occurs in 4.6-8.0 per 1000 people with diabetes annually. DKA is the first event in T1DM at a rate of 21.1%, more often in children under 5 years old. Mortality rate in DKA is at 4%. DKA is characterized by a complete lack of insulin and hypersecretion of competitive hormones leading to increased release of glucose by the liver (a process that is normally suppressed by insulin) from glycogen via glycogenolysis and also through gluconeogenesis. High glucose levels spill over into the urine, taking water and solutes (such as sodium and potassium) along with it in a process known as osmotic diuresis. This causes polyuria, dehydration and polydipsia. The absence of insulin also provokes release of free fatty acids from adipose tissue (lipolysis), which are converted through a process called beta oxidation, again in the liver, into ketone bodies (acetoacetate and β-hydroxybutyrate acids). The ketone bodies, however, have a low pKa and therefore turn the blood acidic (metabolic acidosis). No causative factor is present at a rate of 22-25%. Triggers may include infection, not taking insulin correctly, myocardial infarction and certain medications such as steroids. The symptoms of an episode of diabetic ketoacidosis usually evolve over a period of about 24 hours. Predominant symptoms are nausea and vomiting, pronounced thirst, excessive urine production and abdominal pain. In severe DKA, breathing becomes rapid and of a deep, gasping character, called "Kussmaul breathing". The abdomen may be tender to the point that a serious abdominal condition may be suspected, such as acute pancreatitis, appendicitis or gastrointestinal perforation. In severe DKA, there may be confusion or a marked decrease in alertness, including coma. On physical examination there is usually clinical evidence of dehydration, such as a dry mouth and decreased skin turgor as well as rapid heart rate and low blood pressure. Often, a "ketotic" odor is present, which is often described as "fruity". Small children with DKA are relatively prone to brain swelling, also called cerebral edeHellenic Diabetological Chronicles 31, 2: 68-69, 2018

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