Diabetic ketoacidosis (DKA) happens when the body has too little insulin. It burns fat for fuel, makes ketones and becomes acidic.
Key symptoms
- Thirst and frequent urination
- Nausea, vomiting, belly pain
- Tiredness, confusion
What you find on exam
- Signs of dehydration, fast heart rate
- Fast deep breathing (Kussmaul)
- Fruity breath smell
- Decreased consciousness in severe cases
Tests
- High blood glucose, usually above 250 mg/dL
- Ketones in blood or urine
- Acidosis: low pH or low bicarbonate, high anion gap
- Potassium, sodium, kidney function
Treatment basics
- IV fluids first
- Check potassium before insulin; replace as needed
- Insulin infusion until ketones clear
- Find and treat the trigger (missed insulin, infection)
Red flags
- Low potassium
- Confusion or coma
- Low blood pressure
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.