Management of diabetic ketoacidosis in internal medicine: insulin protocols, electrolyte balance, and clinical outcomes

Samar Abed Alharbi; Amjad Mohammed Meshari; Zainab Abdulaziz Henawi; Reem Mohammed Alsaadi; Shaher Saad Alqarni; Ali Fuad Al Hani; Ola Hussain Alhamrani; Laila Mohammed Saptan; Zainab Abduljabbar Al Hamoud; Nawaf Khalid Alshanbri; Zainab Abdulmonem Jafar; Abdelrahman Farag

doi:10.18203/2394-6040.ijcmph20233833

Authors

Samar Abed Alharbi Department of Internal Medicine, Al Thager Hospital, Jeddah, Saudi Arabia
Amjad Mohammed Meshari College of Medicine, Jazan University, Jazan, Saudi Arabia
Zainab Abdulaziz Henawi Al Naeem Primary Healthcare Center, King Fahad General Hospital, Jeddah, Saudi Arabia
Reem Mohammed Alsaadi Primary Healthcare, King Fahad General Hospital, Jeddah, Saudi Arabia
Shaher Saad Alqarni Nursing Department, General Thriban Hospital, Thriban, Saudi Arabia
Ali Fuad Al Hani College of Medicine, Medical University of Lodz, Lodz, Poland
Ola Hussain Alhamrani Al-Faisaliah Health Center, Ministry of Health, Hofuf, Saudi Arabia
Laila Mohammed Saptan College of Medicine, King Khalid University, Abha, Saudi Arabia
Zainab Abduljabbar Al Hamoud Department of Intensive Care Unit, Qatif Health Network, Saihat, Saudi Arabia
Nawaf Khalid Alshanbri College of Medicine, King Abdulaziz Primary University, Jeddah, Saudi Arabia
Zainab Abdulmonem Jafar Department of Nephrology, Al Noor Specialist Hospital, Mecca, Saudi Arabia
Abdelrahman Farag Mahsa University, Petaling Jaya, Malaysia

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20233833

Keywords:

DM, DKA, Insulin therapy, Fluid resuscitation, Electrolyte imbalances

Abstract

Diabetic ketoacidosis (DKA) is a critical complication of diabetes mellitus (DM), characterized by hyper-glycemia, acidosis, and ketosis. It poses a substantial risk of morbidity and mortality, especially in type 1 DM patients. DKA can be triggered by various factors, including insulin deficiency, infections, alcohol abuse, and other medical conditions. Hospital admissions for DKA are increasing, with mortality rates of up to 5-9%, often linked to severe underlying illnesses and complications such as myocardial infarction and stroke. Effective DKA management involves rehydration, correction of electrolyte imbalances, insulin administration, and addressing precipitating factors. Fluid resuscitation with isotonic saline is vital to restore hydration, and continuous intravenous insulin infusion is the preferred method to control blood glucose and suppress ketone production. Electrolyte imbalances, particularly potassium, sodium, phosphate, and magnesium, require careful monitoring and correction. Clinical outcomes in DKA management include resolving acidosis, normalizing blood glucose, and restoring electrolyte balance, all while achieving and maintaining clinical stability. Complications like cerebral edema and acute respiratory distress syndrome can significantly impact the prognosis. Long-term considerations encompass diabetes management, patient education, and follow-up care.

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