The DOI matches its Crossref record; 261 of the 262 references it cites were found in a registry or an index, and 1 are not checked yet.
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.
Overview
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“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]
The cited source says what the claim attributes to it.
In the citing paper
“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]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Citations
Cites
Items 201–262 of 262
Kalscheuer, H., Seufert, J., Lanzinger, S., Rosenbauer, J., Karges, W., Bergis, D., Mader, J. K., Zimny, S., Schmid, S. M., Hummel, M., et al. (2019) · Diabetes Care · doi:10.2337/dc18-1160 · Cited by 40
Li, J., Yang, D., Yan, J., Huang, B., Zhang, Y., Weng, J., & For the Guangdong Type 1 Diabetes Translational Study Group (2014) · Diabetes/Metabolism Research and Reviews · doi:10.1002/dmrr.2547 · Cited by 38
The Use of Alkali Therapy in Severe Diabetic Ketoacidosis
Latif, K. A., Freire, A. X., Kitabchi, A. E., Umpierrez, G. E., & Qureshi, N. (2002) · Diabetes Care · doi:10.2337/diacare.25.11.2113 · Cited by 37
Self-citationGarrett, C. J., Choudhary, P., Amiel, S. A., Fonagy, P., & Ismail, K. (2019) · Diabetic Medicine · doi:10.1111/dme.14109 · Cited by 37
Dixon, A., Jude, E. B., Banerjee, A. K., et al. (2006) · Diabetic Medicine · doi:10.1111/j.1464-5491.2006.01822.x · Cited by 36
A Prospective Study of the “Two-Bag System” in Diabetic Ketoacidosis Management
Poirier, M. P., Greer, D. M., & Satin-Smith, M. S. (2004) · Clinical Pediatrics · doi:10.1177/000992280404300904 · Cited by 36
Hypertension despite dehydration during severe pediatric diabetic ketoacidosis
Deeter, K. H., Roberts, J. S., Bradford, H. M., Richards, T. L., Shaw, D., Marro, K. I., Chiu, H. K., Pihoker, C., Lynn, A. M., & Vavilala, M. S. (2011) · Pediatric Diabetes · doi:10.1111/j.1399-5448.2010.00695.x · Cited by 35
Hurtado, C., Lemor, A., Vallejo, F., Lopez, K., Garcia, R., Mathew, J. P., & Galindo, R. J. (2019) · Endocrine Practice · doi:10.4158/ep-2018-0457 · Cited by 35
Diabulimia: the world’s most dangerous eating disorder
Torjesen, I. (2019) · BMJ · doi:10.1136/bmj.l982 · Cited by 34
Risk Factors for Recurrent Diabetic Ketoacidosis in Adults With Type 1 Diabetes
Degan, S. D., Dubé, F., Gagnon, C., & Boulet, G. (2019) · Canadian Journal of Diabetes · doi:10.1016/j.jcjd.2019.01.008 · Cited by 33
Dhatariya, K. (2007) · BMJ · doi:10.1136/bmj.39237.661111.80 · Cited by 32
Self-citationAcute Hemolytic Anemia Caused by Severe Hypophosphatemia in Diabetic Ketoacidosis
Shilo, S., Werner, D., & Hershko, C. (2009) · Acta Haematologica · doi:10.1159/000206275 · Cited by 31
Simultaneous Acute Cerebral and Pulmonary Edema Complicating Diabetic Ketoacidosis
Young, M. (1995) · Diabetes Care · doi:10.2337/diacare.18.9.1288 · Cited by 30
DiMeglio, L. A., Chaet, M. S., Quigley, C. A., et al. (2003) · Journal of Pediatric Surgery · doi:10.1016/s0022-3468(03)00510-4 · Cited by 29
Pediatric Type 1 Diabetes: Reducing Admission Rates for Diabetes Ketoacidosis
Ilkowitz, J. T., Choi, S. J., Rinke, M. L., Vandervoot, K., & Heptulla, R. A. (2016) · Quality Management in Health Care · doi:10.1097/qmh.0000000000000109 · Cited by 29
Should we treat infection or inflammation to prevent T2DM?
Vaarala, O., & Yki‐Järvinen, H. (2012) · Nature Reviews Endocrinology · doi:10.1038/nrendo.2012.31 · Cited by 28
Hoffman, W., Passmore, G., Hannon, D., Talor, M., Fox, P., Brailer, C., Haislip, D., Keel, C. P., Harris, G., Rose, N., et al. (2013) · PLoS ONE · doi:10.1371/journal.pone.0071905 · Cited by 28
Kutlu, A. O., Kara, C., & Çetinkaya, S. Ç. (2011) · Pediatric Emergency Care · doi:10.1097/pec.0b013e31821dc68a · Cited by 26
Respiratory failure in a diabetic ketoacidosis patient with severe hypophosphatemia
Choi, H. S., Kwon, A., Chae, H. W., et al. (2018) · Annals of Pediatric Endocrinology & Metabolism · doi:10.6065/apem.2018.23.2.103 · Cited by 26
Access to insulin: applying the concept of security of supply to medicines
Beran, D., Mirza, Z., & Dong, J. (2019) · Bulletin of the World Health Organization · doi:10.2471/blt.18.217612 · Cited by 26
Necrosis of the ileum in a diabetic adolescent
Chan‐Cua, S., Jones, K. L., Lynch, F. P., et al. (1992) · Journal of Pediatric Surgery · doi:10.1016/0022-3468(92)90798-c · Cited by 25
MacFarlane, J., & Dhatariya, K. (2019) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2019.06.009 · Cited by 25
Self-citationLimenis, E., Shulman, R. M., & Daneman, D. (2012) · Diabetes Care · doi:10.2337/dc11-1980 · Cited by 22
Glaser, N. S., Little, C., Lo, W., Cohen, M., Tancredi, D. J., Wulff, H., & O’Donnell, M. E. (2016) · Pediatric Diabetes · doi:10.1111/pedi.12396 · Cited by 22
Self-citationDhatariya, K., Parsekar, K., Skedgel, C. D., Datta, V., Hill, P., & Fordham, R. J. (2019) · Diabetic Medicine · doi:10.1111/dme.13893 · Cited by 22
Self-citationPrice, H. C., Ismail, K., & Care, T. J. B. D. S. (. F. I. (2018) · Diabetic Medicine · doi:10.1111/dme.13673 · Cited by 21
Atkin, S. L., Coady, A., Horton, D., Sutaria, N., Sellars, L., & Walton, C. (1995) · Diabetic Medicine · doi:10.1111/j.1464-5491.1995.tb00470.x · Cited by 20
Approach to the Treatment of Diabetic Ketoacidosis
Kamel, K. S., Schreiber, M., Carlotti, A. P. D. C. P., & Halperin, M. L. (2016) · American Journal of Kidney Diseases · doi:10.1053/j.ajkd.2016.05.034 · Cited by 20
A Rare and Lethal Complication: Cerebral Edema in the Adult Patient with Diabetic Ketoacidosis
Meaden, C. W., Kushner, B., & Barnes, S. (2018) · Case Reports in Emergency Medicine · doi:10.1155/2018/5043752 · Cited by 20
A nationwide study of continuous subcutaneous insulin infusion (CSII) in Denmark
Nørgaard, K. (2003) · Diabetic Medicine · doi:10.1046/j.1464-5491.2003.00909.x · Cited by 19
Brugada Pattern in Diabetic Ketoacidosis: A Case Report and Scoping Study
Haseeb, S., Kariyanna, P. T., Jayarangaiah, A., et al. (2018) · American Journal of Medical Case Reports · doi:10.12691/ajmcr-6-9-2 · Cited by 19
Small Fiber Neuropathy in Children: Two Case Reports Illustrating the Importance of Recognition
Hoeijmakers, J. G. J., Faber, C. G., Miedema, C. J., et al. (2016) · PEDIATRICS · doi:10.1542/peds.2016-1215 · Cited by 18
Miszczuk, K., Mroczek-Wacinska, J., Piekarski, R., et al. (2019) · The Italian Journal of Pediatrics/Italian journal of pediatrics · doi:10.1186/s13052-019-0633-y · Cited by 18
Oh, G. J., Anderson, S. E., Tancredi, D. J., et al. (2009) · Archives of Pediatrics and Adolescent Medicine · doi:10.1001/archpediatrics.2009.106 · Cited by 17
Bonfanti, R., Bognetti, E., Meschi, F., Medaglini, S., D’Angelo, A., & Chiumello, G. (1994) · Acta Diabetologica · doi:10.1007/bf00570376 · Cited by 17
Edge, J., Nunney, I., & Dhatariya, K. (2016) · Diabetic Medicine · doi:10.1111/dme.13065 · Cited by 17
Self-citationFinn, B. P., Fraser, B., & O'Connell, S. M. (2018) · BMJ Case Reports · doi:10.1136/bcr-2017-222861 · Cited by 17
Diabetes specialist nurse telemedicine: admissions avoidance, costs and casemix
Evans, N. R., Richardson, L. S., Dhatariya, K., et al. (2012) · European Diabetes Nursing · doi:10.1002/edn.198 · Cited by 16
Self-citationShen, X., Li, J., Zou, S.-B., Wu, H., & Zhang, Y. (2012) · Journal of Diabetes and its Complications · doi:10.1016/j.jdiacomp.2012.04.010 · Cited by 15
Diabetic Ketoacidosis Among Patients Treated With Continuous Subcutaneous Insulin Infusion
Dogan, A. D. A., Jørgensen, U. L., & Gjessing, H. J. (2017) · Journal of Diabetes Science and Technology · doi:10.1177/1932296816668375 · Cited by 15
Scordi-Bello, I. A., Kirsch, D. A., & Hammers, J. (2016) · Academic Forensic Pathology · doi:10.23907/2016.022 · Cited by 15
Multiple organ failure and prognosis in adult patients with diabetic ketoacidosis.
Oschatz, E., Müllner, M., Herkner, H., et al. (1999) · PubMed · Cited by 14
Diabetic ketoacidosis complicated by generalized venous thrombosis
Cherian, S. V., Khara, L., Das, S., et al. (2012) · Blood Coagulation & Fibrinolysis · doi:10.1097/mbc.0b013e32834fb599 · Cited by 14
Brugada phenocopy associated with diabetic ketoacidosis in two pediatric patients
Alanzalon, R. E., Burris, J., & Vinocur, J. M. (2017) · Journal of Electrocardiology · doi:10.1016/j.jelectrocard.2017.10.017 · Cited by 14
Hypokalaemia and refractory asystole complicating diabetic ketoacidosis, lessons for prevention
Abdulaziz, S., Dabbagh, O. C., Daker, M. O. A., & Hassan, I. S. A. (2012) · BMJ Case Reports · doi:10.1136/bcr-2012-007312 · Cited by 13
Mulukutla, S. N., Acevedo-Calado, M., Hampe, C. S., Pietropaolo, M., & Balasubramanyam, A. (2018) · Diabetes Care · doi:10.2337/dc18-0613 · Cited by 13
Myocardial dysfunction associated with diabetic ketoacidosis in a 5-year-old girl
Halloum, A., & Neyadi, S. A. (2019) · SAGE Open Medical Case Reports · doi:10.1177/2050313x19847797 · Cited by 12
Mulder, L. L., Onur, Ö., Kleis, L., et al. (2014) · Journal of Pediatric Endocrinology and Metabolism · doi:10.1515/jpem-2013-0312 · Cited by 11
Baszyńska–Wilk, M., Wysocka‐Mincewicz, M., Świercz, A., Świderska, J., Marszał, M., & Szalecki, M. (2017) · Journal of Clinical Research in Pediatric Endocrinology · doi:10.4274/jcrpe.5374 · Cited by 11
Ventricular tachycardia in a child with diabetic ketoacidosis without heart disease
McGreevy, M. B., Beerman, L. B., & Arora, G. (2015) · Cardiology in the Young · doi:10.1017/s1047951115000621 · Cited by 10
Nao, J., Zhang, H., Wu, S., et al. (2018) · Child s Nervous System · doi:10.1007/s00381-018-3724-y · Cited by 9
Acute Renal Failure Due to Rhabdomyolysis in Diabetic Patients
Higa, E. M. S., Dib, S. A., Martins, J. R. M., et al. (1997) · Renal Failure · doi:10.3109/08860229709026291 · Cited by 8
Thrombocytopenia‐associated multi‐organ failure caused by diabetic ketoacidosis
Alsaied, T., Goldstein, S. L., Kaddourah, A., et al. (2015) · Pediatrics International · doi:10.1111/ped.12780 · Cited by 8
Finn, B. P., Power, C., McSweeney, N., Breen, D. M., Wyse, G. M., & O'Connell, S. M. (2018) · Pediatric Diabetes · doi:10.1111/pedi.12760 · Cited by 7
Acute Multiple Arteriovenous Thromboses in a Patient with Diabetic Ketoacidosis
Wakabayashi, S., Tsujimoto, T., Kishimoto, M., et al. (2015) · Internal Medicine · doi:10.2169/internalmedicine.54.4087 · Cited by 6
Ahmed, M., Healy, M.-L., O’Shea, D., et al. (2016) · BMJ Case Reports · doi:10.1136/bcr-2016-216295 · Cited by 6
Severe Myopericarditis in Diabetic Ketoacidosis—All Troponin are Not Myocardial Infarction
Odubanjo, A. A., Kalisetti, R., Adrah, R., et al. (2018) · Clinical Medicine Insights Case Reports · doi:10.1177/1179547618763356 · Cited by 6
Reddi, A. S. (2019) · Springer eBooks · doi:10.1007/978-3-030-28895-2_6 · Cited by 3
Wildenhoff, K. E., Ladefoged, K., & Sörensen, N. S. (1975) · Scandinavian Journal of Clinical and Laboratory Investigation · doi:10.3109/00365517509087216 · Cited by 3
Jørgensen, L. B., Skov, O., & Yderstræde, K. B. (2014) · BMJ Case Reports · doi:10.1136/bcr-2013-202139 · Cited by 2
THE CHEMISTRY OF THE URINE IN DIABETES MELLITUS.
Munson, E. L. (1897) · JAMA · doi:10.1001/jama.1897.02440180017002c · Cited by 2
Laffel (1999) · doi:10.1002/(sici)1520-7560(199911/12)15:6
Flagged first, then by citations
Research works printed but not linked: 9
- Skinner, T. C. Recurrent diabetic ketoacidosis: causes, prevention and management. Horm. Res. 57 (Suppl. 1), 78–80 (2002).
- Otieno, C. F., Kayima, J. K., Omonge, E. O. & Oyoo, G. O. Diabetic ketoacidosis: risk factors, mechanisms and management strategies in sub-Saharan Africa: a review. East Afr. Med. J. 82, S197–203 (2005).
- So, T. Y. & Grunewalder, E. Evaluation of the two-bag system for fluid management in pediatric patients with diabetic ketoacidosis. J. Pediatr. Pharmacol. Ther. 14, 100–105 (2009).
- Roscoe, J. M., Halperin, M. L., Rolleston, F. S. & Goldstein, M. B. Hyperglycemia-induced hyponatremia: metabolic considerations in calculation of serum sodium depression. CMAJ 112, 452–453 (1975).
- Pain, A. R., Pomroy, J. & Benjamin, A. Hamman’s syndrome in diabetic ketoacidosis. Endocrinol. Diabetes Metab. Case Rep. 2017, 17–0135 (2017).
- Patra, K. P. & Scott, L. K. Diabetic ketoacidosis preceding thrombocytopenia associated multiple organ failure in a child. JOP 12, 40–43 (2011).
- Atabek, M. E., Pirgon, O., Oran, B., Erkul, I. & Kurtoglu, S. Increased cardiac troponin I concentration in diabetic ketoacidosis. J. Ped. Endocrinol. Metab. 17, 1077–1082 (2004).
- Buckingham, B. A., Roe, T. F. & Yoon, J. W. Rhabdomyolysis in diabetic ketoacidosis. JAMA Pediatr. 135, 352–354 (1981).
- Kussmaul, A., Foulis, D. & Gemmell, S. On a peculiar mode of death in diabetes; on acetonæmia; on the treatment of diabetes by glycerine, and injection of diastase into the blood. GMJ 6, 485–500 (1874).
Cited by
Sorted by citations
Blonde, L., Umpierrez, G. E., Reddy, S. S., McGill, J. B., Berga, S. L., Bush, M., Chandrasekaran, S., DeFronzo, R. A., Einhorn, D., Galindo, R. J., et al. (2022) · Endocrine Practice · doi:10.1016/j.eprac.2022.08.002 · Cited by 507
Self-citationSacks, D. B., Arnold, M., Bakris, G. L., Bruns, D. E., Horvath, A. R., Lernmark, Å., Metzger, B. E., Nathan, D. M., & Kirkman, M. S. (2023) · Diabetes Care · doi:10.2337/dci23-0036 · Cited by 351
Hyperglycemic crises in adults with diabetes: a consensus report
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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
