Diabetic ketoacidosis. How to treat and, when possible, prevent

Treatment and prevention of diabetic ketoacidosis (DKA) should be guided by an understanding of the metabolic decompensation that occurs in this medical emergency. The primary cause of DKA is insulin deficiency, which may be precipitated by infection or other forms of stress. As hyperglycemia exceeds the renal threshold, it leads to osmotic diuresis, electrolyte loss, and eventually dehydration. Treatment, therefore, consists primarily of insulin administration and replacement of fluid and electrolytes. Likewise, prevention hinges on avoiding insulin deficiency by tight control of blood glucose levels and compensation for stress. Because of the metabolic derangements of DKA, some laboratory tests can be misleading and need to be carefully interpreted.