Last Updated on February 4, 2023
Introduction
- Occurs in 10% of
DKA
, where blood glucose level is normal×DKA
Abbreviation: DKA
Notes:
• Abdominal pain is a common presentation for DKA (with underlying newly diagnosed DM)
- Starvation -> ketosis with normoglycaemia
Definition
- Plasma glucose <11 mmol/L
- Metabolic acidosis (pH <7.30, HCO3 <15 mmol/L)
- Ketonaemia (serum ketone >3 mmol/L)
Risk Factors
- Pregnancy
- SGLT2 inhibitor
- Recent surgery
- Infection
- Poor oral intake / Prolonged fasting
- Omission / Reduction of
insulin
dose×Insulin
Types of insulin
🚪 Prandial insulin (Bolus)
• Short acting: Actrapid®, Humulin R, Insuman R, Insugen R
• Rapid analogue: Aspart (Novorapid®), Lispro (Humalog®), Glulisine (Apidra®)🚪 Basal insulin
• Intermediate-acting: Insulatard®, Hululin N, Insuman N, Insugen N
• Long-acting analogue: Glargine, Detemir, Degludec🚪 Premixed insulin
• Mixtard 30, Humulin 30/30, Novomix 30, Humalog mix 25/75, Humalog mix 50/50Source: CPG Management of Type 2 Diabetes Mellitus
- Alcohol consumption
Management
- Follow
DKA
protocol×DKA
Abbreviation: DKA
Notes:
• Abdominal pain is a common presentation for DKA (with underlying newly diagnosed DM)
Others
- Withhold SGLT2-inhibitor until ketoacidosis resolves and patient is tolerating oral intake
- Fluid of choice:
-
Dehydration
: NSD5% or D5%×Dehydration
Dehydration
- Normohydration: D10%
-
Dehydration
Pitfalls
- High index of suspicion for those who have risk factors euglycaemic
DKA
has normal dxt×DKA
Abbreviation: DKA
Notes:
• Abdominal pain is a common presentation for DKA (with underlying newly diagnosed DM)
×dxtDxt
An abbreviation of Dextrostix, commonly referred to capillary blood glucose
Related Posts
References
- CPG Management of Type 2 Diabetes Mellitus, 6th Ed
- Eugycemic diabetic ketoacidosis, NCBI