DKA

Created by: dr. Ardiles

What are the Warning Signs of DKA?
Signs
•DKA usually develops
slowly.
•Thirst or a very dry mouth
•Frequent urination
•High blood glucose (blood
•sugar) levels
•High levels of ketones in the
urine
Simptom
•Constantly feeling tired Dry
•flushed skin Nausea,
vomiting, or abdominal
pain
•Difficulty breathing
•Fruity odor on breath
•A hard time paying
attention, or confusion
 Ketones Criteria
advise to check your urine for ketones when
your blood glucose is more than 240 mg/dl
check for ketones every 4 to 6 hours
High levels of ketones and high blood glucose
levels can mean your diabetes is out of control
 Etiology
1. Not enough insulin
• Maybe you did not inject enough insulin
• body could need more insulin than usual because
of illness
2. Not enough food
• Sometimes resulting in high ketone level
• High levels may also occur when you miss a meal
3. Insulin reaction (low blood glucose)
• If testing shows high ketone levels in the morning,
you may have had an insulin reaction while asleep
 Suspect DKA or HHS in an ILL Patient with
Hyperglycemia (usually)

DKA HHS
• Ketoacidosis • Minimal acid-base problem
• ECFV contraction • ECFV contraction
• Milder hyperosmolarity • Hyperosmolarity
• Normal to high glucose • Marked hyperglycemia
• May haveLOC • Marked LOC
• Beware hypokalemia • Beware hypokalemia
• Must use insulin • May need insulin
• Absolute insulin deficiency + • Relative insulin deficiency
glucagon
ECFV = extracellular fluid volume; LOC = level of consciousness
ECFV = extracellular fluid volume;
LOC = level of consciousness
Management of DKA in Adults
 Fluids, Potassium, Acidosis are the Pillars of
Treatment

IV fluids Serum Acidosis

Potassium
 Fluid

Two in one
Four in four
One in four
Fluid
Potassium

Correct
potassium
first, then
Insulin
Acidosis with Insulin
Treatment

BTK