Diabetic ketoacidosis

Dhatariya, Ketan K.; Glaser, Nicole S.; Codner, Ethel; Umpierrez, Guillermo E.

doi:10.1038/s41572-020-0165-1

Cited by 461Diabetes Management and ResearchHyperglycemia and glycemic control in critically ill and hospitalized patientsDiabetes Treatment and Management

Diabetic ketoacidosis

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Dhatariya, Ketan K., Glaser, Nicole S., Codner, Ethel, Umpierrez, Guillermo E.·2020·Nature Reviews Disease Primers

DOI 10.1038/s41572-020-0165-1

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Abstract

Diabetic ketoacidosis (DKA) is the most common acute hyperglycaemic emergency in people with diabetes mellitus. A diagnosis of DKA is confirmed when all of the three criteria are present - 'D', either elevated blood glucose levels or a family history of diabetes mellitus; 'K', the presence of high urinary or blood ketoacids; and 'A', a high anion gap metabolic acidosis. Early diagnosis and management are paramount to improve patient outcomes. The mainstays of treatment include restoration of circulating volume, insulin therapy, electrolyte replacement and treatment of any underlying precipitating event. Without optimal treatment, DKA remains a condition with appreciable, although largely preventable, morbidity and mortality. In this Primer, we discuss the epidemiology, pathogenesis, risk factors and diagnosis of DKA and provide practical recommendations for the management of DKA in adults and children.

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Acetoacetate and acetone may increase as beta-hydroxybutyrate falls during successful therapy of diabetic ketoacidosis.
“since AcAc and acetone may increase as bOHB falls during successful therapy (295,298).”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [298]
The Diagnosis section (page unavailable) says β-hydroxybutyrate should decrease following fluid and intravenous insulin treatment. It discusses acetoacetate testing but does not say acetoacetate increases during successful therapy, and the searched passages do not report an increase in acetone. (LLM, conf=0.84)
Experimental — accuracy not yet measured
The two major mechanisms responsible for the high ketone concentrations in people with diabetes are increased production from triglycerides and decreased utilization in the liver, both a result of absolute or relative insulin deficiency and increased counterregulatory hormones including cortisol, epinephrine, glucagon, and growth hormone.
“The two major mechanisms responsible for the high ketone concentrations in people with diabetes are increased production from triglycerides and decreased utilization in the liver, both a result of absolute or relative insulin deficiency and increased counterregulatory hormones including cortisol, epinephrine, glucagon, and growth hormone (298).”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [298]
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measured
Blood ketone determinations that measure beta-hydroxybutyrate specifically are useful for both diagnosis and ongoing monitoring of diabetic ketoacidosis.
“Blood ketone determinations that measure bOHB specifically are useful for both diagnosis (299,301) and ongoing monitoring of DKA (298,299).”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [298]
Beta-hydroxybutyrate is the predominant ketone body in diabetic ketoacidosis.
“bOHB, the predominant ketone body in DKA, is not detected.”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [298]

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Authors: Dhatariya, K. K., Glaser, N. S., Codner, E., & Umpierrez, G. E.
Affiliations: University of East Anglia (GB)
University of California, Davis (US)
Emory University (US)
Corresponding author: Umpierrez, Guillermo E.
ORCID: Dhatariya, Ketan K.
Glaser, Nicole S.
Umpierrez, Guillermo E.
Venue: Nature Reviews Disease Primers
Publisher: Springer Science and Business Media LLC
Published: 2020-05-14
Volume: 6
Issue: 1
Pages: 40-40
ISSN: 2056-676X (ISSN-L)
DOI: 10.1038/s41572-020-0165-1
OpenAlex: W4211168619
Semantic Scholar: 179f2399452aa8fc8e0d1e96ab44d05d41c6e226
Cited by: 461
References: 262
Citations by year: 2026: 80 · 2025: 104 · 2024: 92 · 2023: 71 · 2022: 63 · 2021: 44 · 2020: 6
FWCI: 7.10
Type: journal article
Language: en
Open access: green
ueaeprints.uea.ac.uk
Licence: www.springernature.com/gp/researchers/text-and-data-mining (tdm)
www.springernature.com/gp/researchers/text-and-data-mining (vor)
Locations: Nature Reviews Disease Primers (publishedVersion)
PubMed (publishedVersion)
UEA Digital Repository (University of East Anglia) (submittedVersion)
Universidad de Chile (submittedVersion, cc-by-nc-nd)
Funders: American Diabetes Association (1-17-IBS-186)
Sanofi
Emory University
Dexcom
Novo Nordisk
Fondo Nacional de Ciencia y Tecnología
National Institutes of Health (P30DK11102, UL1TR002378)
National Institute of Diabetes and Digestive and Kidney Diseases (P30DK11102, P30DK111024)
National Center for Advancing Translational Sciences
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
Keywords: diabetic ketoacidosis, diabetes mellitus, anion gap metabolic acidosis, ketone bodies, insulin therapy, fluid resuscitation, electrolyte replacement, pathogenesis, risk factors, diagnosis, recurrence prevention, children
MeSH terms: Acidosis, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Fluid Therapy, Humans, Hypoglycemic Agents, Insulin, Risk Factors, Diabetic Ketoacidosis, Disease Management

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