Diabetic ketoacidosis: a current appraisal of pathophysiology and management

Clin Pediatr (Phila). 2009 Mar;48(2):135-44. doi: 10.1177/0009922808323907. Epub 2008 Nov 20.


Diabetic ketoacidosis (DKA) is a frequent abnormal metabolic entity seen in high-dependency units such as critical care units and in the emergency department. Having an understanding of its pathophysiology, a consequence of absent to low insulin levels, delineates the clinical presentation. Most clinical features are caused by hyperglycemia and acidosis, including weight loss. The newer management modalities are discussed that include the need for intensive laboratory workup, meticulous monitoring of the insulin, and fluid management. Among the complications, cerebral edema (CE) is the most dreaded, albeit with low incidence. The new insights into its pathophysiology and management are outlined, and a timeline for management of DKA is proposed.

MeSH terms

  • Blood Glucose / metabolism
  • Clinical Protocols / standards
  • Diabetic Ketoacidosis / etiology
  • Diabetic Ketoacidosis / physiopathology*
  • Diabetic Ketoacidosis / therapy
  • Electrolytes / blood
  • Fluid Therapy
  • Gluconeogenesis / physiology*
  • Glycolysis / physiology*
  • Humans
  • Insulin / physiology
  • Risk Factors
  • Socioeconomic Factors
  • Urea / blood


  • Blood Glucose
  • Electrolytes
  • Insulin
  • Urea