Etiology

• Most often in T1DM: Poorly controlled/new onset
• (RARE) Can be seen in T2DM → experiencing extreme physiologic stress
• Infections, !Sepsis
• CAD → !MI
• Thyrotoxicosis ↑(hyperthyroidism)
• Drugs
  • • SGLT2i (”gliflozin”) make DKA euglycemic

Presentation

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Traid of

• ↑ Hyperglycemia (> 7): Random Glucose (2.5 - 6)

• Ketone: ‣

• AGMA </aside>

• Beware of !Hyperkalemia - ↑K (> 5)

Approach

• Hx

  • Symptoms of Diabetes (Polyuria, Polydipsia)
  • Lethargic (GCS 13–15)
  • Abdominal Pain - Diffused Abdominal Pain
  • N/V - Nausea/vomitting
  • Weight loss
  • Recent illness/infection

• Physical Exam

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  • ABCs (primary survey)

    • • Bedside Glucose Check (POC Glucose ) </aside>

  • May have Altered Mental Status (AMS)

  • Hypotension ↓(<90/60)

  • !Hypovolemia ↓ (ECFVD - Volume depletion and Dehydration)

  • Kussmual Respiration

  • Fruity Breath

Investigations

• ABG or VBG → confirm metabolic acidosis
• sCr (60-100 umol/L) , Serum Osmolality (275-295), Serum Lactate (< 4.0 mmol/L)
• Comprehensive Metabolic Panel (Blood Test)

Diagnostic Criteria

• Random Glucose (2.5 - 6) > 250 mg/dL (13.9 mmol/L)