Endocrinology

Diabetic Ketoacidosis

당뇨성케톤산증

Insulin deficiency + counter-regulatory hormones cause ketoacidosis and hyperglycemia

Written and edited by Dr. Kwang Lee, D.C., L.Ac. · Updated 2026-10-04

How common: Common T1DM complication
Typical age: Mostly T1DM patients

What is it?

Insulin deficiency + counter-regulatory hormones cause lipolysis → ketones → acidosis.

Commonly affected: Systemic (metabolism, CV, brain)

How it develops

Insulin deficiency + stressInfection, insulin omission, new T1DM
Counter-reg hormone surgeGlucagon, cortisol, epinephrine rise
Lipolysis → ketogenesisFFA → β-hydroxybutyrate + acetoacetate
AG acidosis + dehydrationpH <7.3, HCO3 <15, osmotic diuresis

Symptoms

Kussmaul respirationDeep rapid breathing (compensatory)
Severe dehydrationDry mucosa, tachycardia
Abdominal pain/vomitingCommon in children; mimics acute abdomen
Altered mental statusMild → coma
Fruity breathAcetone breath odor

How it is examined

ABG + electrolytespH <7.3, HCO3 <15, AG >12
Serum/urine ketonesβ-hydroxybutyrate ≥3 mmol/L
Workup for triggerInfection, MI workup (CBC, CXR, ECG, cultures)

Imaging

CXR to evaluate precipitants like pneumonia.

Pneumonia
Congestion

Brain CT/MRI if cerebral edema suspected (esp. children).

Cerebral edema

Non-surgical care

IV fluids (NS 1 L/hr)Aggressive first 1–2h, then 0.45% NS
IV regular insulin 0.1 U/kg/hrAdd D5W when glucose reaches 250
Potassium replacementStart when K <5.2 (insulin shifts K intracellularly)
Treat precipitantAntibiotics for infection, ACS care if MI
Monitor anion gapContinue IV insulin until AG normalizes

Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.

When surgery is considered

None

Outlook

Mortality <5% with treatment; pediatric cerebral edema 20–50%.