Description
Although the literature is replete with publications on diabetic ketoacidosis the evidence management of this condition is largely at level 3 (descriptive study) or level 4 (“expert” opinion). Such controlled trials as there are, are usually not randomised and the numbers of patients studied are often too small to allow meaningful interpretation. A commonly accepted definition of diabetic ketoacidosis (D.K.A) is ketonaemia > 5 mmol/L occurring in a diabetic without other causes. This is not useful practically, as most hospitals do not include acetoacetate and betahydroxybuterate among their emergency investigations. The diagnosis is usually made in a patient with hyperglycaemia > 12 mmol/L (usually > 20 mmol/L), acidosis with a pH < 7.3 and/or a bicarbonate of < 15 mmol/L, and heavy ketonuria. This paper discusses aetiology and management of D.K.A.
