2006, Number 4
An Med Asoc Med Hosp ABC 2006; 51 (4)
Tavera HM, Coyote EN
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ABSTRACTDiabetic ketoacidosis (DKA) is one of the most serious acute complications of diabetes mellitus. It consists of the biochemical triad of hyperglycemia › 300 mg/dL, metabolic acidosis pH ‹ 7.3, HCO3 › 15 mmol/L, and ketonemia with ketonuria › 3 mmol/L. All patients with diabetes, regardless of type, can present diabetic ketoacidosis at the time of diagnosis, with non-compliance of insulin treatment, or in association with a febrile illness. Diabetic ketoacidosis is caused by insulin deficiency, either relative or absolute and to excessive secretion of counterregulatory hormones that promote ketogenesis and acidosis. The clinical picture can be serious, including extreme dehydration, electrolitic disturbance, hypotension and altered mental status. May be clinically confused with acute abdomen. Diagnosis is confirmed in the presence of hyperglycemia › 300 mg/dL, acidemia and ketosis. General principles in the management include correction of fluid deficits and electrolyte disturbances, interrupting ketoacid production and lowering plasma glucose with insulin therapy. Rapid correction of metabolic abnormalities should be avoided to decrease the risk for precipitating cerebral edema.