MICU intern's survival guide diabetic ketoacidosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Diabetic ketoacidosis Microchapters
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Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Diabetic ketoacidosis from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic study of choice
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
Chest X Ray
CT
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Echocardiography or Ultrasound
Other Imaging Findings
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Treatment
Medical Therapy
Surgery
Primary Prevention
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Cost-Effectiveness of Therapy
Future or Investigational Therapies
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Case #1
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Step 1: Confirm the diagnosis of Diabetic ketoacidosis

History

• Polydipsia
• Polyuria
• Confusion
• Vomiting
• Weakness
• Abdominal pain
• Weight loss

Physical examination

• Assess for dehydration.
• Kussmaul's breathing (deep sighing respiration)
• Ketone breath
• Lethargy
• Drowsiness

Initial Laboratory works

• Blood glucose > 200mg/dL
• Acidosis pH < 7.3
• Ketone in blood and urine
• Blood electrolytes and urea

Step 3: Initial management

Management if the patient is in shock

• Attention to ABC.
• Airway +/- NG tube
• Breathing 100% oxygen
• Circulation (10 ml/kg of .9% NS, replete until circulation restored, maximum 3 doses)