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Date of Award

Spring 2022

Degree Name

Master of Medical Science (Physician Assistant)

Department

Physician Assistant; College of Health Sciences

First Advisor

Samantha Creamer

Abstract

Diabetic ketoacidosis (DKA) is a preventable and treatable complication associated with diabetes mellitus. Assessing metabolic abnormalities appropriately and timely is crucial in determining steps for treatment to prevent further complications. It is defined as hyperglycemia, ketosis, and metabolic acidosis, most commonly caused by infection and insulin omission. As blood glucose rises uninhibited by insulin, hepatic gluconeogenesis occurs, followed by breakdown of triglycerides. Products of lipolysis are oxidized in the liver to form ketone bodies, which are excreted through the urine with glucose. Patients become markedly dehydrated, which will allow further hyperglycemia and ketonemia, as the body is unable to excrete them in the urine. Diagnosis includes measurement of blood glucose levels, serum and urine ketones, and assessment of metabolic acidosis through arterial pH and anion gap. Treatment should begin with fluid resuscitation, with isotonic (0.9% NaCl) saline. Once blood glucose has decreased, dextrose should be added to prevent hypoglycemia with concomitant insulin administration. Insulin should be administered after assessment of hyperglycemia and potassium levels, as not to cause hypokalemia. Potassium should be supplemented as levels are decreased during insulin administration, which will lower serum potassium. Bicarbonate therapy is not recommended to resolve acidosis, though it has a theoretical benefit. Complications include hypoglycemia, hypokalemia, and most fatally cerebral edema. With proper assessment of metabolic abnormalities, appropriate administration of treatment regimens, and continued monitoring during treatment administration, DKA can be a treatable condition without further complication or mortality.

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CME Article: Diabetic Ketoacidosis (DKA)

Diabetic ketoacidosis (DKA) is a preventable and treatable complication associated with diabetes mellitus. Assessing metabolic abnormalities appropriately and timely is crucial in determining steps for treatment to prevent further complications. It is defined as hyperglycemia, ketosis, and metabolic acidosis, most commonly caused by infection and insulin omission. As blood glucose rises uninhibited by insulin, hepatic gluconeogenesis occurs, followed by breakdown of triglycerides. Products of lipolysis are oxidized in the liver to form ketone bodies, which are excreted through the urine with glucose. Patients become markedly dehydrated, which will allow further hyperglycemia and ketonemia, as the body is unable to excrete them in the urine. Diagnosis includes measurement of blood glucose levels, serum and urine ketones, and assessment of metabolic acidosis through arterial pH and anion gap. Treatment should begin with fluid resuscitation, with isotonic (0.9% NaCl) saline. Once blood glucose has decreased, dextrose should be added to prevent hypoglycemia with concomitant insulin administration. Insulin should be administered after assessment of hyperglycemia and potassium levels, as not to cause hypokalemia. Potassium should be supplemented as levels are decreased during insulin administration, which will lower serum potassium. Bicarbonate therapy is not recommended to resolve acidosis, though it has a theoretical benefit. Complications include hypoglycemia, hypokalemia, and most fatally cerebral edema. With proper assessment of metabolic abnormalities, appropriate administration of treatment regimens, and continued monitoring during treatment administration, DKA can be a treatable condition without further complication or mortality.