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Diabetic ketoacidosis
Open accessAbstract
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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“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]
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“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]
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“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]
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“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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Umpierrez, G. E., Davis, G. M., ElSayed, N. A., Fadini, G. P., Galindo, R. J., Hirsch, I. B., Klonoff, D. C., McCoy, R. G., Misra, S., Gabbay, R. A., et al. (2024) · Diabetes Care · doi:10.2337/dci24-0032 · Cited by 278
Self-citationJensen, E. T., Stafford, J. M., Saydah, S., D’Agostino, R. B., Dolan, L. M., Lawrence, J. M., Marcovina, S., Mayer-Davis, E. J., Pihoker, C., Rewers, A., et al. (2021) · Diabetes Care · doi:10.2337/dc20-0389 · Cited by 137
Yang, Z., Yu, M., Mei, M., Chen, C., Lv, Y., Xiang, L., & Li, R. (2022) · Nutrition Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2021.10.003 · Cited by 37
Metadata
- 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.
- Venue
- Nature Reviews Disease Primers
- Published
- 2020-05-14
- Volume
- 6
- Issue
- 1
- Pages
- 40-40
- ISSN
- 2056-676X (ISSN-L)
- 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
- 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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