PRIMEVIEW

DIABETIC KETOACIDOSIS
In T1DM and T2DM, For the Primer, visit doi: 10.1038/s41572-020-0180-2
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is accompanied by DIAGNOSIS
Diabetic ketoacidosis (DKA) is the
MECHANISMS elevation of counter-
most common hyperglycaemic
regulatory hormones DKA frequently presents with a short history,
emergency in people with diabetes
mellitus and results in the triad of and symptoms — which include hyperglycaemia,
Free polyuria and polydipsia — usually develop over
events of hyperglycaemia, ketosis and
fatty acids a few hours. Abdominal pain is present in ~60%
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are oxidized of patients; mental
in the liver status and level
The low pH due to acidosis
VQ|MGVQPGU of consciousness
H+ can lead to neurological
EPIDEMIOLOGY Insulin vary between
dysfunction, leading to coma and,
deficiency if untreated, death individuals
The incidence of DKA is 13–80% in both adults and leads to H+ depending on
children with type 1 diabetes mellitus (T1DM). The increased hepatic the severity of
incidence of DKA as the initial presentation glucose production hyperglycaemia
of T2DM (known as ketosis-prone T2DM) is and reduced glucose and acidosis.
increasing worldwide, with uptake in peripheral Various
an incidence of 11% in tissues, leading to international
children, whereas the hyperglycaemia guidelines suggest
incidence in adults that the presence
is unknown. of hyperglycaemia
Glucose, and acidosis
ketones H+ and positive
and free ketone tests confirm a diagnosis, although the
fatty acids methods of documenting ketosis (urine versus
Precipitating factors include infection, H+ DNQQF|XCT[
acute coronary syndromes, insulin H+
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omission or issues of pump malfunction
of counter-
regulatory hormones
lead to increased OUTLOOK
lipolysis, releasing
MANAGEMENT large quantities of free Several strategies have
H+
HCVV[|CEKFUCUYGNNCU been proposed to reduce
The goal of therapy is to correct acidaemia, reduced insulin Accumulation DKA events, including
action of ketoacids
restore circulatory volume and normalize Individuals early screening, close
blood glucose concentrations and electrolyte with DKA decreases serum follow-up of high-risk
H+
disturbances. Most people are treated initially exhibit deep and bicarbonate levels individuals (those with
with intravenous insulin. A ‘two-bag’ method of laboured breathing, and leads to the multiple admissions
fluid replacement is often used — intravenous QȎGPYKVJCnHTWKV[o development of for DKA), availability of
fluid without dextrose initially and, upon odour indicative of metabolic telephone support from
volume correction, infusion with dextrose excess acetone acidosis diabetes specialist nurses
correction to prevent hypoglycaemia caused by and targeted programmes
H+
the insulin therapy. Upon resolution of DKA and to educate parents and
once patients are eating and drinking normally, communities. In some parts of the world,
maintenance therapy is implemented with efforts to ensure easy availability of insulin at an
subcutaneous insulin. Severe hyperglycaemia affordable price are needed.
and high ketone
concentrations cause
doi:10.1038/s41572-020-0165-1; Article citation ID: (2020) 6:41 osmotic diuresis Written by Deepitha Maennich; designed by Laura Marshall
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