Diabetic Ketoacidosis (DKA) Quiz

Diabetic Ketoacidosis (DKA)

• Acute metabolic complication of diabetes resulting from absolute insulin deficiency, and a medical emergency with important complications
• Mortality rates have fallen in the UK, but a single episode is associated with a 5% risk of death, rising to 25% in recurrent cases
• Most commonly occurs in people with type 1 diabetes, but can also occur in type 2 diabetes, particularly in those with significant β-cell dysfunction

Diagnosis of DKA

• Hyperglycaemia (blood glucose >11.1 mmol/L or 200 mg/dL)
• Hyperketonemia (≥3.0 mmol/L on fingerprick testing) or ketonuria (more than 2+ on urine dipstick testing)
• Metabolic acidosis (venous bicarbonate <15 mmol/L or pH <7.3)

Hyperosmolar Hyperglycemic State (HHS)

• Associated with a higher mortality rate (up to 20%) due to age and frailty of the population
• Pathogenesis is incompletely understood
• Caused by an osmotic diuresis, leading to dehydration and hypernatraemia
• Fluid loss can be substantial (10-22 L in a person weighing 100 kg)
• Reason for lack of significant ketoacidosis is unclear, possibly due to insulin levels sufficient to prevent lipolysis and ketogenesis

Precipitating Factors and Prognosis of HHS

• Common precipitating factors: infection, acute illness, drug therapy, and postoperative hospitalization
• Poor prognostic signs: hypothermia, hypotension, serum osmolality >360 mOsmol/kg, and multiple comorbidities

Management of HHS

• Aims: normalize osmolality and blood glucose, replace fluid and electrolyte losses, and prevent complications
• Slower approach to correction of metabolic abnormalities recommended, avoiding rapid shifts in osmolality
• Co-morbidities must be taken into account, such as cardiac failure and delirium

Test your knowledge of Diabetic Ketoacidosis, a medical emergency and acute metabolic complication of diabetes, its diagnosis, and risks.