Diabetic Ketoacidosis (DKA)
DKA is a condition that occurs in diabetics due to lack of insulin. Lack of insulin leads to hyperglycemia and hyperketonemia with production of acetoacetic acid and β-hydroxybutyric acid that create metabolic acidosis. Hyperglycemia causes osmotic diuresis which leads to severe dehydration.
Signs and symptoms may include nausea, vomiting, abdominal pain, thirst, excessive urine output, dehydration with tachycardia and hypotension. Breathing may be deep and rapid (Kussmaul respirations). The patient's breath may smell “fruity” due to exhaled acetone.
Without treatment DKA progresses to coma and death.
Diagnostic Criteria for Diabetic Ketoacidosis [1]
Plasma glucose >250 mg/dL* , arterial pH <7.3, and positive serum and/or urine ketones (especially 3β-hydroxybutyrate).
| Severity | Arterial pH | Serum bicarbonate (mEq/L) | Mental status |
| Mild | 7.25–7.30 | 15–18 | Alert |
| Moderate | 7.00–7.24 | 10 to <15 | Drowsy |
| Severe | <7.00 | <10 | Stupor / coma |
* DKA may occur with relatively low blood sugar levels during pregnancy.
Precipitating Factors for Diabetic Ketoacidosis in Pregnancy [2]
Protracted vomiting, starvation, use of β-sympathomimetic agents for tocolysis, infection, new-onset diabetes, poor control of blood sugars or poor compliance with treatment, insulin pump failure, and steroid use for fetal lung maturation or chronic medical disorders.
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