Evaluation and Management of the Critically Ill Adult With Diabetic Ketoacidosis

Abstract

Background: Diabetic ketoacidosis (DKA) is a hyperglycemic emergency that presents commonly to the emergency department. Severe DKA has the potential for significant morbidity and mortality if not recognized early and treated appropriately. It is incumbent on the emergency clinician to be vigilant in the management of these critically ill patients.

Objective: This narrative review evaluates the emergency medicine management of the adult patient with severe DKA.

Discussion: DKA is a condition found most commonly in patients with insulin-dependent diabetes, often due to nonadherence with diabetic medications or an inciting event, such as infection or ischemia. The severity of DKA is classified based on the level of acidosis present rather than absolute glucose level. The management of severe DKA involves assessing and treating the inciting event, fluid hydration, insulin, and potassium repletion. Close monitoring is necessary to prevent the complications that can occur.

Conclusions: DKA is a medical condition that has the potential for significant morbidity and mortality if not recognized and managed appropriately.

Keywords: diabetes; diabetic ketoacidosis; endocrine; hyperglycemia; ketones; metabolic acidosis.