Diabetic ketoacidosis (DKA)

DKA is a complex disordered metabolic state characterized by hyperglycemia, ketoacidosis, and ketonuria.
DKA is an acute and potentially life threatening complication of diabetes caused by an inadequate concentration of insulin in the blood for the body’s requirements.
DKA may be the first presentation of diabetes mellitus and can have significant mortality if misdiagnosed or mistreated. DKA usually occurs in patients with type 1 diabetes though it is not uncommon in some patients with type 2 diabetes.

• Lack of sufficient insulin administration or omission of insulin
• Sepsis with bacterial, viral or fungal infections may present as initial manifestation of diabetes
• Exacerbation of co-existing chronic illness
• Acute cardiovascular, cerebrovascular event
• High dose steroids (without proactive adjustment of insulin)

The most common causes of DKA are underlying infection, disruption of insulin treatment, and new onset of diabetes. Insulin error is the most common precipitating factor, accounting for nearly two thirds of cases (excluding those where DKA was the first presentation of diabetes mellitus).

DKA may also occur in pregnant women, either in those with pre-existing diabetes or diabetes diagnosed when pregnant. Acute myocardial infarction can also precipitate DKA.