Diabetic Ketoacidosis

Author: Adrian Robert Marsh / Editor: Lou Mitchell / Reviewer: Nicholas Blundell, Mehdi Teeli / Codes: O7 / Published: 08/11/2021


Diabetic ketoacidosis (DKA) is a common presentation to the emergency department (ED). The presentation can mimic many other disease processes. The ED physician must be able to diagnose, appropriately investigate, initiate treatment and manage complications.

After completing this session you will be able to:

  • Differentiate diabetic ketoacidosis (DKA) from other causes of acute illness
  • Interpret the results of appropriate investigations in DKA
  • Plan the initial management of a patient with DKA
  • Anticipate complications of DKA and their management
  • Evaluate the factors which contribute to the presentation of, and response to treatment of DKA


  1. Joint British Diabetes Societies Inpatient Care Group. The Management of Diabetic Ketoacidosis in Adults. Revised: 2021.
  2. Savage WM, Kivlert A. ABCD guidelines for the management of hyperglycaemic emergencies in adults. Practical diabetes int, 2006, 23(5), pp. 227-231.
  3. Chiasson JL, Aris-Jilwan N, Belanger R, Bertrand S, et al. Diagnosis and treatment of diabetic ketoacidosis and the hyperglycaemic hyperosmolar state. 2003, 168(7) pp.859-866.
  4. Kitabchi AE, Wall BM. Diabetic ketoacidosis. Med Clin North Am. 1995 Jan;79(1):9-37.
  5. Foster DW, McGarry JD. The metabolic derangements and treatment of diabetic ketoacidosis. N Engl J Med. 1983 Jul 21;309(3):159-69.
  6. Adrogu HJ, Eknoyan G, Suki WK. Diabetic ketoacidosis: role of the kidney in the acid-base homeostasis re-evaluated. Kidney Int. 1984 Apr;25(4):591-8.
  7. Abbas E, Kitabchi AE, Guillermo E, et al. Hyperglycemic crises in adult patients with diabetes. A consensus statement from the diabetes association. Diabetes Car; 2006, 29: pp.2739-2748.
  8. Umpierrez GE, Murphy MB and Kitabchi AE. Diabetic ketoacidosis and hyperglycemic hyperosmolar syndrom. Diabetes Spectrum 2002 Jan; 15(1): 28-36.
  9. Gerich JE, Lorenzi M, Bier DM, et al. Effects of physiologic levels of glucagon and growth hormone on human carbohydrate and lipid metabolism. Studies involving administration of exogenous hormone during suppression of endogenous hormone secretion with somatostatin. J Clin Invest. 1976 Apr;57(4):875-84.
  10. McGarry JD, Woeltje KF, Kuwajima M, Foster DW. Regulation of ketogenesis and the renaissance of carnitine palmitoyltransferase. Diabetes Metab Rev. 1989 May;5(3):271-84.
  11. Felig P, Wahren J. Influence of endogenous insulin secretion on splanchnic glucose and amino acid metabolism in man. J Clin Invest. 1971;50(8):1702-1711.
  12. Edwards CRW, Bouchier IAD, Haslett C, Chilvers ER. (1995) Davidsons Principles and Practice of Medicine. 17th Edition. Churchill Livingstone.; pp.728-732.
  13. Diabetes UK. (1994). Diabetes in the UK 2004.
  14. Research and statistics. gov.uk
  15. Trachtenbarg DE. Diabetic ketoacidosis. Am Fam Physician. 2005 May 1;71(9):1705-14. PMID: 15887449.
  16. English P, Williams G. Hyperglycaemic crises and lactic acidosis in diabetes mellitus. Postgrad Med J. 2004 May;80(943):253-61.
  17. Umpierrez GE, Khajavi M, Kitabchi AE. Review: diabetic ketoacidosis and hyperglycemic hyperosmolar nonketotic syndrome. Am J Med Sci. 1996 May;311(5):225-33.
  18. Hennis ED, Stahl E and Kreisberg RA. (1994) The hyperosmolar hyperglycaemic syndrome. Diabetes Rev; 2: pp.115.
  19. Brandenburg MA, Dire DJ. Comparison of arterial and venous blood gas values in the initial emergency department evaluation of patients with diabetic ketoacidosis. Ann Emerg Med. 1998 Apr;31(4):459-65.
  20. Ma OJ, Rush MD, Godfrey MM, Gaddis G. Arterial blood gas results rarely influence emergency physician management of patients with suspected diabetic ketoacidosis. Acad Emerg Med. 2003 Aug;10(8):836-41.
  21. Gokel Y, Paydas S, Koseoglu Z, et al. Comparison of blood gas and acid-base measurements in arterial and venous blood samples in patients with uremic acidosis and diabetic ketoacidosis in the emergency room. Am J Nephrol. 2000 Jul-Aug;20(4):319-23.
  22. Umpierrez G, Korytkowski M. Diabetic emergencies – ketoacidosis, hyperglycaemic hyperosmolar state and hypoglycaemia. Nat Rev Endocrinol. 2016 Apr;12(4):222-32.
  23. Dhatariya KK, Glaser NS, Codner E, Umpierrez GE. Diabetic ketoacidosis. Nature Reviews Disease Primers 2020;6:40.
  24. Morris LR, Murphy MB, Kitabchi AE. Bicarbonate therapy in severe diabetic ketoacidosis. Ann Intern Med. 1986 Dec;105(6):836-40.

Comments are closed