Diabetic ketoacidosis
Summary
DKA is a life-threatening complication of diabetes with hyperglycemia, high anion gap metabolic acidosis, and ketosis, typically in Type 1 diabetes. Requires emergent insulin, fluids, and electrolyte repletion.
Detail
Insulin deficiency allows uncontrolled lipolysis; FFAs are oxidized to ketone bodies faster than they can be utilized, causing ketonemia and metabolic acidosis. Hyperglycemia develops from unopposed gluconeogenesis. Precipitants: infection, insulin omission, acute illness, SGLT2 inhibitors. Presents with polyuria, polydipsia, Kussmaul respirations, abdominal pain. Treatment: IV normal saline, insulin infusion (titrate to drop glucose 50-75 mg/dL/hr), K+ repletion once <5.5 mEq/L, treat precipitant.
Sources
- First Aid for the USMLE Step 1
- Pathoma
- Harrison's Principles of Internal Medicine
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