Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is caused by a deficiency in insulin combined with an increase in the counterregulatory hormones such as glucagon, catecholamines, cortisol, and growth hormone. These hormonal alterations lead to a state of severe volume depletion, acidemia, ketonemia, and electrolyte abnormalities that are fatal in up to 5% of patients. About 10% of diabetics will make their initial presentation while in DKA. It is most commonly associated with Type 1 (insulin-dependent) diabetes but may develop in Type 2 diabetes as well. Although poor compliance is a common cause of DKA, in most cases severe stress, such as sepsis, trauma, surgery, drugs, pregnancy, or myocardial infarction, is the initiating factor.