Developments in the management of diabetic ketoacidosis in adults: implications for anaesthetists

Abstract

### Key points Diabetic ketoacidosis (DKA) is a medical emergency. The diagnostic triad is: 1. Ketonaemia ≥3.0 mmol litre−1 or significant ketonuria (more than 2+ on urine sticks) 2. Blood glucose >11.0 mmol litre−1 or known diabetes mellitus 3. Bicarbonate <15.0 mmol litre−1, venous pH <7.3, or both. DKA can occur in both type 1 and type 2 diabetes mellitus and, although preventable, it remains a frequent and life-threatening complication. Errors in the management of DKA are not uncommon and are associated with significant morbidity and mortality. The majority of mortality and morbidity in DKA are attributable to delays in presentation and initiation of treatment. Rapid recognition and treatment of DKA is critical. To overcome these concerns and to highlight current management strategies, the Joint British Diabetes Societies (JBDS) published guidelines in 2010. This was updated in consultation with the Intensive Care Society in September 2013.1 This article will review the pathophysiology of DKA and highlight the modern management of DKA that is relevant for anaesthetists. A summary of the JBDS guidelines pertinent to intensivists has been published.2 In England in 2010, there were 14 375 admissions to …