Feature Article

Diabetic ketoacidosis

Caroline Bachmeier, Kunwarjit S. Sangla


© ron bailey/istockphoto.com
© ron bailey/istockphoto.com


Diabetic ketoacidosis (DKA) is a serious complication among people with diabetes that requires prompt recognition and treatment. This article describes precipitating causes and the presentation and diagnosis of DKA in adults. It provides an overview of acute management and strategies for preventing this emergency.

Key Points

  • Diabetic ketoacidosis (DKA) is a common complication of type 1 diabetes, and sometimes also type 2 diabetes, with associated high morbidity and mortality.
  • A diagnosis of DKA classically comprises hyperglycaemia, hyperketonaemia and metabolic acidosis.
  • DKA can be present in patients with only mildly elevated or normal blood glucose levels. This condition is called euglycaemic ketoacidosis and may occur with sodium-glucose cotransporter-2 inhibitors, in pregnancy or in states of impaired gluconeogenesis such as liver failure or alcohol abuse.
  • Apart from measuring blood glucose levels, ketone testing should be performed and this is best done with point-of-care ketone measuring devices.
  • Management objectives of DKA include fluid resuscitation and correction of hyperglycaemia, ketogenesis and acid-base imbalances. Established protocols should be used in treating DKA.
  • Causes should be identified and treated, and preventive measures with sick day management plans and involvement of a multidisciplinary team should be implemented.