DKA
Formal Definition
Diabetic Ketoacidosis; a life-threatening complication of diabetes (predominantly type 1, though also type 2) characterized by the triad of hyperglycemia (glucose typically >250 mg/dL), high anion gap metabolic acidosis, and ketonemia/ketonuria, resulting from absolute or relative insulin deficiency causing unregulated lipolysis and ketone production.
How It's Used on the Ward
"Patient is in DKA" — one of the most frequently managed endocrine emergencies, recognized by the triad and treated with the DKA protocol (fluids, insulin, electrolyte replacement).
Example
""19-year-old type 1 diabetic with 2 days of nausea and vomiting: glucose 487, bicarb 8, pH 7.18, ketones large, anion gap 28 — clear DKA. Starting 1L NS bolus, insulin drip at 0.1 units/kg/hr, potassium replacement before insulin if K < 3.5.""
Clinical Context
DKA management: 1) Fluids first — 1–2L NS bolus for hemodynamic stabilization. 2) Electrolytes — potassium MUST be ≥3.5 before starting insulin (insulin drives K into cells, worsening hypokalemia). 3) Insulin drip — 0.1 units/kg/hr. 4) Check glucose hourly, add dextrose to IV fluids when glucose <250 to prevent hypoglycemia. 5) Monitor for resolution: AG closure + bicarb >18 + pH >7.30 + able to eat. DO NOT stop insulin drip just because glucose normalizes — wait for AG closure. Precipitants: new diagnosis, missed insulin, infection, MI.
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