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DKA in Type 1 Diabetes

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Dr Siddhant Trehan, Gurugram    24 November 2018

  1. Insulin deficiency with raised levels of counter-regulatory hormones leads to diabetic ketoacidosis (DKA).
  2. DKA occurs mostly in type 1 diabetes, whereas hyperosmolar hyperglycemic state (HHS) is more common in type 2 diabetes.
  3. Increased lipolysis and increased supply of free fatty acid (FFA) for hepatic fatty acid oxidation lead to ketoacidosis.
  4. The most common symptoms of DKA are polydipsia and polyuria while the most common symptom of HHS is altered sensorium.
  5. Metabolic acidosis in DKA needs to be corrected by intravenous bicarbonate infusion, only if pH ≤6.9.
  6. Cerebral edema is a rare but frequently fatal complication of DKA, occurring in 0.7-1.0% of children with DKA. Hypoxemia and, rarely, noncardiogenic pulmonary edema may also complicate the treatment of DKA.
  7. Better education of caregivers as well as patients regarding signs and symptoms of new-onset diabetes; conditions, procedures and medications that worsen diabetes control and the use of glucose monitoring, could potentially decrease the incidence and severity of DKA.

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