Diabetic ketoacidosis (DKA) is one of the most common hyperglycemic complications of diabetes mellitus (DM) that is encountered in clinical practice as anesthesiologists and intensivists. Various stressors can lead to DKA in a diabetic patient, but it also remains a common manifestation at the outset of the disease among young diabetics. Thorough knowledge of the disease pathophysiology and treatment modalities help to reduce both duration of ICU stay and the morbidity and mortality associated with DKA.
Karslioglu French E, Donihi AC, Korytkowski MT. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome: review of acute decompensated diabetes in adult patients. BMJ 2019;365:l1114. DOI: 10.1136/bmj.l1114.
Klingensmith GJ, Tamborlane WV, Wood J, et al. Pediatric diabetes consortium. diabetic ketoacidosis at diabetes onset: still an all too common threat in youth. J Pediatr 2013;162(2):330-4.e1. DOI: 10.1016/j.jpeds.2012.06.058.
Quinn M, Fleischman A, Rosner B, et al. Characteristics at diagnosis of type 1 diabetes in children younger than 6 years. J Pediatr 2006;148(3):366–371. DOI: 10.1016/j.jpeds.2005.10.029.
Endocrine problems in the critically ill 1: diabetes and glycaemic control. BJA.
Brutsaert E, (2019). Diabetic Ketoacidosis (DKA) - Endocrine and Metabolic Disorders - MSD Manual Professional Edition. Retrieved 20 November 2019, from https://www.msdmanuals.com/en-in/professional/endocrine-and-metabolic-disorders/diabetes-mellitus-and-disorders-of-carbohydrate-metabolism/diabetic-ketoacidosis-dka.
Peden NR, Braaten JT, McKendry JB. Diabetic ketoacidosis during long-term treatment with continuous subcutaneous insulin infusion. Diabetes Care 1984;7(1):1–5. DOI: 10.2337/diacare.7.1.1.
Malone ML, Gennis V, Goodwin JS. Characteristics of diabetic ketoacidosis in older versus younger adults. J Am Geriatr Soc 1992;40(11):1100–1104. DOI: 10.1111/j.1532-5415.1992.tb01797.x.
Nyenwe EA, Razavi LN, Kitabchi AE, et al. Acidosis: the prime determinant of depressed sensorium in diabetic ketoacidosis. Diabetes Care 2010;33(8):1837–1839. DOI: 10.2337/dc10-0102.
Edge JA, Hawkins MM, Winter DL, et al. The risk and outcome of cerebral oedema developing during diabetic ketoacidosis. Arch Dis Child 2001;85(1):16–22. DOI: 10.1136/adc.85.1.16.
Dhatariya KK. Diabetic ketoacidosis and hyperosmolar crisis in adults. Medicine 2019;47(1):46–51. DOI: 10.1016/j.mpmed.2018.10.001.
Kitabchi AE, Umpierrez GE, Miles JM, et al. Hyperglycemic crises in adult patients with diabetes: a consensus statement from the American Diabetes Association. Diabetes Care 2009;32(7):1335–1343. DOI: 10.2337/dc09-9032.
Wolfsdorf JI, Glaser N, Agus M, et al. ISPAD clinical practice consensus guidelines 2018: diabetic ketoacidosis and the hyperglycemic hyperosmolar state. Pediatr Diabetes 2018;19(Suppl 27):155–177. DOI: 10.1111/pedi.12701.
Nallasamy K, Jayashree M, Singhi S, et al. Low-dose vs standard-dose insulin in pediatric diabetic ketoacidosis: a randomized clinical trial. JAMA Pediatr 2014;168(11):999–1005. DOI: 10.1001/jamapediatrics.2014.1211.
Puttha R, Cooke D, Subbarayan A, et al. North west England paediatric diabetes network. low dose (0.05 units/kg/h) is comparable with standard dose (0.1 units/kg/h) intravenous insulin infusion for the initial treatment of diabetic ketoacidosis in children with type 1 diabetes-an observational study. Pediatr Diabetes 2010;11(1):12–17. DOI: 10.1111/j.1399-5448.2009.00536.x.
Chua HR, Schneider A, Bellomo R. Bicarbonate in diabetic ketoacidosis – a systematic review. Ann Intensive Care 2011;1(1):23. DOI: 10.1186/2110-5820-1-23.
Dhatariya KK, Umpierrez GE. Guidelines for management of diabetic ketoacidosis: time to revise? Lancet Diabetes Endocrinol 2017;5(5):321–323. DOI: 10.1016/S2213-8587(17)30093-1.
Zhong VW, Juhaeri J, Mayer-Davis EJ. Trends in hospital admission for diabetic ketoacidosis in adults with type 1 and type 2 diabetes in England, 1998-2013: a retrospective cohort study. Diabetes Care 2018;41(9):1870–1877. DOI: 10.2337/dc17-1583.
Mendez Y, Surani S, Varon J. Diabetic ketoacidosis: treatment in the intensive care unit or general medical/surgical ward? World J Diabetes 2017;8(2):40–44. DOI: 10.4239/wjd.v8.i2.40.
Venkatesh B, Pilcher D, Prins J, et al. Incidence and outcome of adults with diabetic ketoacidosis admitted to ICUs in Australia and New Zealand. Crit Care 2015;19(1):451. DOI: 10.1186/s13054-015-1171-7.
Ramaesh A. Incidence and long-term outcomes of adult patients with diabetic ketoacidosis admitted to intensive care: a retrospective cohort study. J Intensive Care Soc 2016;17(3):222–233. DOI: 10.1177/1751143716644458.