Diagnosis/Labs
This is the classic triad of DKA.
What are hyperglycemia, metabolic acidosis, and ketosis?
DKA develops when this hormonal deficiency triggers lipolysis, ketogenesis, gluconeogenesis, and glycogenolysis.
What is a relative lack of insulin?
This is the first step in the management of pediatric DKA.
What is fluid resuscitation?
The most feared complication of DKA in children.
What is cerebral edema?
Despite the absence of significant ketosis, this hyperglycemic emergency can mimic DKA and has been described in adolescents with type 2 diabetes.
What is hyperosmolar hyperglycemic state (HHS)?
This is the diagnostic threshold for blood glucose in DKA.
What is >200 mg/dL?
This is the major metabolic consequences of a relative lack of insulin.
lipolysis, ketogenesis, gluconeogenesis, and glycogenolysis
This lab value is the most reliable for assessing resolution of ketoacidosis.
What is the anion gap?
This is a typical sign of cerebral edema on exam.
What is altered mental status?
This electrolyte, often elevated from isotonic saline, can cause a misleading acidosis that is not clinically significant.
What is chloride?
In DKA, this ketone body is the predominant circulating ketone, and the one most responsible for the anion gap.
What is β-hydroxybutyrate?
Despite profound total body depletion, this electrolyte is often elevated in the serum on arrival due to acidosis-driven H⁺/K⁺ exchange and lack of insulin to move it intracellularly.
What is potassium?
Normal saline can cause this type of metabolic acidosis, which may falsely suggest ongoing DKA if clinicians rely only on pH or bicarbonate levels.
What is a hyperchloremic non–anion gap metabolic acidosis?
The first-line treatment for suspected cerebral edema.
What is hypertonic saline or mannitol?
When the anion gap has closed and the patient is ready to eat, this is the timing of subcutaneous insulin in relation to the IV insulin drip.
What is give the subcutaneous insulin with the meal and continue IV insulin for 30 minutes before stopping?
This lab value is the most reliable for assessing the severity of acidosis.
What is serum pH or bicarbonate?
In DKA, hyperglycemia exceeds the renal glucose threshold of ~200 mg/dL, triggering this process that leads to hypovolemia and total body potassium and phosphorus depletion.
What is osmotic diuresis?
During DKA treatment, urine ketones may increase even though the patient is improving, because β-hydroxybutyrate is being converted into this ketone body measured on urine tests.
What is acetoacetate?
This bedside maneuver is a simple but essential step in treating cerebral edema.
What is elevating the head of the bed to 30 degrees?
This classic physical exam finding in DKA sounds like the patient is trying to sigh their way out of acidosis.
What is Kussmaul breathing?
In early DKA management, this lab may transiently worsen (drop) even though the metabolic acidosis is improving, due to dilution and chloride load.
What is bicarbonate?
This acid accumulates due to lipolysis and fatty acid metabolism.
What is beta-hydroxybutyric acid?
This should not be routinely administered to patients despite their acidosis
What is bicarbonate?
One reason intubating a DKA patient is risky is because of this physiologic challenge that’s hard to reproduce mechanically.
What is profound hyperventilation?
You should never stop insulin until you see this on your labs—even if the blood sugar is normal.
What is a closed anion gap? (Glucose isn’t the villain here, ketones are.)