Literature Review on Diabetic Ketoacidosis

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Vanderbilt University
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Literature review
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Overview of the Disorder

Diabetic ketoacidosis or DKA is one of the most life-threatening metabolic disorders observed in both humans and the veterinary medicine. As a severe complication of diabetes mellitus, DKA is characterized by the deficiency of Insulin and the increased hormones such as the glucagon, cortisol, catecholamine, as well as the growth hormones. Fundamentally, the increased hormones secretion and the insulin deficiency often lead to dehydration, electrolyte imbalance, the hyperglycemia, and ketosis. Such conditions are also associated with the presence of the substances called the ketones in urine and decreased the concentration of the bicarbonate in the blood. Some dogs with the DKA often depicts less disorders effects. However, the majority of the animals become seriously ill and therefore develop serious complications such as the neurological problems due to the brain swelling, acute kidney failure, pancreatitis, and the anemia. In most of the occasions, DKA will often lead to death, but proper diagnosis and treatment are crucial in saving the life. Many studies have shown that DKA develops in the previously unrecognized or treated diabetes. In this sense, the identification of diabetes mellitus or the development of the additional symptoms in the patient or animal known to be diabetic to prevent the disorder from occurring is substantially crucial (Guthrie, Guthrie, & Guthrie, 2002).

Clinical Signs of the DKA and Explanations

DKA is defined clinically as an acute state of severe unregulated diabetes associated with the ketoacidosis-producing derangements in the intermediary metabolism. The major primary causes of DKA include the underlying infection, disruption of the insulin treatment and the new development of diabetes (Rewers et al. 2008). Biochemically, the DKA is demonstrated as an increase in the serum concentration of ketones greater than the 5mEq/L, the blood glucose level higher than 250mg/dL, and the blood PH of less than 7.3. It is important to recognize that DKA symptoms often develop rapidly, sometimes within the first 24 hours of infection (Rewers et al. 2008). In some individuals, these signs and symptoms may be a clear and first indication of having diabetes. On a wider note, these symptoms may include the excessive thirst, frequent urination, abdominal pain, weakness and fatigue, nausea and vomiting, as well as breathing problems (Shereen, 2013).

More specific-signs of Diabetic ketoacidosis which can be substantially detected through the blood and urine testing kits include the increased blood sugar and ketones level in the urine. Fundamentally, ketones are used for energy generation in many body tissues. Their formation occurs when the fatty acids are produced from the fat tissue and are consequently carried to the liver (Shereen, 2013). The liver after that manufactures ketones from fatty acids. It is important to recognize that the excessive production of ketone can take place in an uncontrolled diabetes mellitus as they increase in number, leading to the development of ketosis and finally acidosis. The studies by Rewers et al. (2008) have shown that DKA is more common in the areas of veterinary medicine but can also be observed in animals such as the dogs with established diabetes that do not receive appropriate treatment with enough insulin. In these dogs, there may be a related inflammatory or infectious disease. Other may also develop various disorders associated with insulin resistance such as hypothyroidism or Cushings disease.

Test, Diagnosis, and Prognosis

Any suspicion regarding the DKA in an individual requires an immediate diagnosis through the appropriate tests. Such test often involves the physical examination and blood test to examine any possible physical manifestation of the disease, as well as in the blood. In some situation, additional tests may be required to assist in determining what triggered the diabetic ketoacidosis. For the blood test, the examination is often done on blood sugar level, Ketone level, and blood acidity (Rewers et al. 2008).

According to Kitabchi et al. (2008), the diagnosis of the DKA is based on the clinical signs and the presence of the increased serum glucose concentration and Ketones in the urine, in addition to the low serum bicarbonate level in the blood. In addition to the concentration of the serum glucose and the urinalysis outcomes, other primary diagnostic techniques include the measurement of venous total carbon dioxide, blood gas assessment, and analysis of electrolytes and serum kidney quantities. In addition to these reports, it is important for the medical experts to conduct a urine culture for any patient or animal suspected with the DKA. It is based on the fact that the urinary tracts are the strong factors which complicate the situation. Conceivably, the examination and getting the information about the complete blood count, serum liver and pancreatic enzyme estimates, and cholesterol and triglyceride levels should also be is crucial. Finally, doctors should conduct the X-rays of the chest and abdomen, in addition to the ultrasound of the abdomen to examine the presence of the associated factors and the abnormalities that may need treatment (Kitabchi et al. 2008).

Treatment and Drugs

DKA is treatable, especially when diagnosed at an earlier stage. The patient may be treated in the emergency room or admitted to the hospital care. Such admission and treatment usually involve various interventions such as the fluid replacement, electrolyte replacement, and the insulin therapy, about the fluid replacement, the patient is made to receive the fluids either by mouth or through the vein (intravenous) until the patient is rehydrated. In such conditions, the fluid is added to the body so as to replace the lost ones through the excessive urination as well helping to dilute the excess sugar in the patients blood (Kitabchi et al. 2008).

In the same way, the electrolyte replacement is crucial in the treatment of DKA (Guthrie, Guthrie, & Guthrie, 2002). Notably, the electrolytes refer to the body minerals that transport the electric charge such as the potassium, chloride, and sodium. The insulin therapy further helps in the reversal of the processes that cause diabetic ketoacidosis. Other than the fluids and the electrolytes, an individual suffering from DKA should also receive an insulin therapy usually through the vein. In an event where the blood sugar goes below 240mg/dL (13.3 mmol/L), and the blood is no longer acidic, the doctor will be able to cease the intravenous insulin therapy and after that resume his or her conventional insulin therapy (Kitabchi et al. 2008).

Management and Prevention of DKA

As Guthrie, Guthrie, & Guthrie (2002) asserts, the administration and prevention of DKA are one of the major ways of reducing the risks and costs involved in its treatment. There are numerous ways through which individuals can do to prevent the diabetic ketoacidosis and other arising complications. Patients commitment to managing their diabetes is a significant step for the disorder prevention. In this way, patients should make healthy eating and physical activity greater components of their daily routine. Administration of the oral insulin or insulin therapy as directed by the doctor is also necessary. Finally, the patients need to monitor their blood sugar level, adjust their insulin dosage as required and assessing the ketone level should be embraced.



Shereen, A. (2013). Diabetic Ketoacidosis: Clinical Practice Guidelines. INTECH Open Access Publisher.

Guthrie, D. W., Guthrie, R. A., & Guthrie, D. W. (2002). Nursing management of diabetes mellitus: A guide to the pattern approach. New York: Springer

Kitabchi, A. E., Umpierrez, G. E., Fisher, J. N., Murphy, M. B., & Stentz, F. B. (2008). Thirty years of personal experience in hyperglycemic crises: diabetic ketoacidosis and hyperglycemic hyperosmolar state. The Journal of Clinical Endocrinology & Metabolism, 93(5), 1541-1552.

Rewers, A., Klingensmith, G., Davis, C., Petitti, D. B., Pihoker, C., Rodriguez, B., ... & Dabelea, D. (2008). Presence of diabetic ketoacidosis at diagnosis of diabetes mellitus in youth: the Search for Diabetes in Youth Study. Pediatrics, 121(5), e1258-e1266.


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