Diabetic Ketoacidosis
All Diseases    System Diseases    eMedicine

General Info

HPI/Physical

Found in Type I Diabetics, often the presenting picture for paitents with new onset of diabetes The pancreas is no longer making insulin. The body is unable to recognize the glucose in the blood. It therefore believes that it is in a starving state and begins finding other sources of energy. The body begins to fatty acids. The fatty acid building block forms ketones in the body through ketone formation so that it had shunt glucose to the brain which can only use glucose for energy.

History: Nausea, Vomiting, Palpitations, Abdominal Pain, Lightheaded, Polyuria, Polydipsia, Confusion Symptoms: Hypotension, Tachycardia, Dehydration, Altered Mental Status, Fruity Breath, Tachycardia, Kussmaul Respirations Signs:

Tests/Diagnosis Management Disposition Basic Metabolic Panel Phosphate Magnesium CBC Serum Ketones ABG Urinalysis EKG Isotonic Fluid: 5-10 Liters - once glucose is 200-250 switch to D5 1/2NS Insulin: 0.1 units/kg/hour - once gap is closed bridge with long acting Lantus Potassium: 20 mEq/L - will be falsely elevated - treat if normal or low Phos./Mag.: if needed Diagnosis: Clinical Picture + Glucose > 250 + Bicarbonate < 15 + pH < 7.3, and Moderate Serum Ketones Anion Gap Metabolic Acidosis Hourly BMP: Glucose, Anion Gap, Potassium Look for Cerebral Edema ICU Consult: Admit ICU Stepdown or medicine floor if gap closed and stable