DIABETIC KETOACIDOCIS

(DKA)

Dr. Mahmoud Elhareth, B.Pharm (clinical pharmacy)

DKA

*Definition
*Signs & Symptoms
*Epidemiology
*Pathophysiology
*Principles of management
Definition
Definition

*“DIABETIC” – hyperglycemia (blood

glucose >200 md/dl
*“KETO” – elevated ketones in blood or
urine
*“ACIDOSIS”- bicarbonate
concentration of <15.0 mmol/L and/or
venous pH <7.3
Signs & Symptoms
Epidemiology
Epidemiology

*DKA occurs predominantly in type 1

diabetes.
*It also occurs in type 2 diabetes
“ketosis-prone diabetes mellitus”.
Pathophysiology
Pathophysiology

Absolute or relative insulin deficiency

Glucagon excess

Enhanced gluconeogenesis & glycogenolysis

Enhanced lipolysis & ketogenesis

Hyperglycemia & ketoacidosis

Principles of management
Principles of management

Fluids Insulin Potassium

Bicarbonate
1- fluid replacement

Isotonic saline is infused at a rate of 15–20 mL/kg

body weight per hour for the first 2 hours, then
according to serum sodium
If the”corrected” Na concentration is :
• <135 meq/L, isotonic saline at a rate of 250-
500ml/hr.
• >135 meq/L, one-half isotonic saline at a rate of
250-500 ml/hr.
2-insulin

*using IV regular insulin give:

1- Bolus dose 0.1 U/kg ( repeat if blood glucose
hasn’t decreased by 50-75 mg/dL after 1 hour).
2- maintenance dose 0.1 U/kg/hr.
3- Once blood glucose reaches 200 mg/dL, reduce
infusion rate to 0.05–0.1 units/kg/hour and add 5%
dextrose.
4-For uncomplicated DKA, SC rapid-acting insulin can
be considered.
3-potassium

*if K is <3.3 mEq/L, give KCL at a rate of 20-40

mEq/hr.
*if K is >3.3 mEq/L but < 5.5 mEq/L, give KCL 20-30
mEq to each liter of fluids.
*if k >5.5 mEq/L, Don’t give KCL and check K every 2
hours.
4-Bicarbonate

*for patients with pH < 6.9, we give 100mEq sodium

bicarbonate.
5- resolution of DKA

*Resolution of DKA is defined as ketones less than 0.6

mmol/L, and venous pH over 7.3.
*Do not rely on bicarbonate alone to assess the
resolution of DKA at this point due to the possible
hyperchloraemia secondary to high volumes of 0.9%
sodium chloride solution.
References
* https://abcd.care/sites/abcd.care/files/site_u
ploads/JBDS_02%20_DKA_Guideline_amended_
v2_June_2021
* Caroline
S. Zeind, Michael G.Carvalho, Applied
therapeutics, Eleventh edition.
* Kitabchi AE,Umpierrez GE, Miles JM, Fisher JN.
Hyperglycemic crises in adult patients with diabetes.
Diabetes Care. 2009 Jul;32(7):1335-43. doi:
10.2337/dc09-9032. PMID: 19564476; PMCID:
PMC2699725.