Comprehensive review of diabetic ketoacidosis: an update

Abstract

The most frequent hyperglycemic emergency and the leading cause of death in people with diabetes mellitus is diabetic ketoacidosis (DKA). DKA is common in people with type 1 diabetes, while type 2 diabetes accounts for roughly one-third of occurrences. Although DKA mortality rates have generally decreased to low levels, they are still significant in many underdeveloped nations. In industrialized countries, its mortality rate ranges from 2 to 5%, but in underdeveloped nations, it ranges from 6 to 24%. Therefore, it is always lethal if misdiagnosed or improperly treated. According to specific research, DKA can be present at the time of type 1 diabetes onset in 25 to 30% of cases and in 4 to 29% of young people with type 2 diabetes mellitus, and its features include hyperglycemia, metabolic acidosis, and ketosis with its triggering factors commonly being infections, newly discovered diabetes, and failure to start insulin therapy. Less than 20% of DKA patients present comatose, and patients with different levels of consciousness can present at other times. A close association between abnormalities found during a mental status evaluation and osmolality seems to exist. Hospital admission is necessary for vigorous intravenous fluid therapy, insulin therapy, electrolyte replacement, diagnosis and treatment of the underlying triggers, and routine monitoring of the patient’s clinical and laboratory conditions to manage DKA properly. Appropriate discharge plans should include actions to prevent a DKA recurrence and the proper selection and administration of insulin regimens.