In people with diabetes mellitus, diabetic ketoacidosis (DKA) is the most common acute emergency due to hyperglycemia. It occurs when there is a lack of insulin, and the body can’t utilize glucose properly. When insulin deficiency happens, the body must use fat for energy instead of glucose which leads to the production of ketones. High levels of ketones can raise the acidity of the blood to toxic levels.1
The American diabetes association and the joint British diabetes society for inpatient care have set the diagnostic criteria for DKA as the combination of:1,2
- Hyperglycemia with a blood glucose >200 mg/dL (11.1mmol/L) or prior history of diabetes.
- β-hydroxybutyrate concentration ≥0 mmol/L OR urine ketone strip ≥2+ or greater
- Arterial or venous pH <7.30 OR bicarbonate concentration 15-18 mmol/L.3
DKA is most common in people with uncontrolled type 1 diabetes. About one-third of children with type 1 diabetes present with DKA at diagnosis. The most frequent causes of DKA are infections (like pneumonia or urinary tract infections), and insulin therapy being stopped. The risk of DKA has also found to be caused by sodium-glucose cotransporter 2 (SGLT2) inhibitors. It may also develop in people with uncontrolled type 2 diabetes, this is often in response to an illness or physiological stress.1 It is also more common in people of African or Asian ancestry.1
Overall mortality in children with DKA varies from 0.15% to 0.35% in developed countries like Canada, United States and Denmark.4-6 Early recognition and rapid treatment, usually in a hospital, is important to prevent morbidity and mortality. DKA is preventable; as such, patient education and support are especially important for patients with diabetes.
References:
- Committee ADAPP. 2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes—2024. Diabetes Care. 2023;47(Supplement_1):S20-S42. doi:10.2337/dc24-S002
- Dhatariya KK, Care TJBDSfI. The management of diabetic ketoacidosis in adults—An updated guideline from the Joint British Diabetes Society for Inpatient Care. Diabetic Medicine. 2022;39(6):e14788. doi:https://doi.org/10.1111/dme.14788
- Umpierrez GE, Davis GM, ElSayed NA, et al. Hyperglycemic Crises in Adults With Diabetes: A Consensus Report. Diabetes Care. 2024;47(8):1257-1275. doi:10.2337/dci24-0032
- Curtis JR, To T, Muirhead S, Cummings E, Daneman D. Recent Trends in Hospitalization for Diabetic Ketoacidosis in Ontario Children. Diabetes Care. 2002;25(9):1591-1596. doi:10.2337/diacare.25.9.1591
- Henriksen OM, Røder ME, Prahl JB, Svendsen OL. Diabetic ketoacidosis in Denmark: Incidence and mortality estimated from public health registries. Diabetes Research and Clinical Practice. 2007;76(1):51-56. doi:10.1016/j.diabres.2006.07.024
- Lawrence SE, Cummings EA, Gaboury I, Daneman D. Population-based study of incidence and risk factors for cerebral edema in pediatric diabetic ketoacidosis. The Journal of Pediatrics. 2005;146(5):688-692. doi:10.1016/j.jpeds.2004.12.041
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