Diabetic Ketoacidosis (DKA) – Emergency Management

Introduction

Diabetic ketoacidosis (DKA) is a life-threatening complication of Type 1 Diabetes Mellitus, characterized by hyperglycemia, ketonemia, and metabolic acidosis.

Pathophysiology

• Insulin deficiency → Lipolysis → Free fatty acids → Ketone body formation → Metabolic acidosis.

Clinical Features

• Polyuria, polydipsia, weight loss.
• Kussmaul breathing, fruity breath (acetone odor).
• Severe dehydration, altered mental status.

Diagnosis

• Hyperglycemia (Blood glucose >250 mg/dL).
• Metabolic acidosis (pH <7.3, bicarbonate <18 mmol/L).
• Ketonemia (Positive serum ketones).

Management (DKA Protocol)

1. IV Fluids (0.9% Normal Saline) – Corrects dehydration.
2. Insulin Therapy (IV Regular Insulin) – Reduces ketone production.
3. Potassium Replacement – Prevents hypokalemia from insulin therapy.
4. Bicarbonate Therapy (Severe cases pH <6.9).

Complications

• Cerebral Edema (Children, Rapid fluid shifts).
• Hypokalemia (Monitor ECG changes).

Conclusion

DKA requires immediate resuscitation and strict electrolyte monitoring. These MBBS notes provide a structured guide to emergency DKA management.