Case of the Month #37 Diabetic Ketoacidosis

Published 16/03/2023

What is the pathophysiology of Diabetic Ketoacidosis?

A number of pathophysiological processes occur in DKA: 

  1. Insulin deficiency (either absolute or relative) is accompanied by an increase in counter-regulatory hormones (glucagon, cortisol, growth hormone, and adrenaline) leading to enhanced hepatic gluconeogenesis and glycogenolysis; this results in significant hyperglycaemia 

  1. Enhanced lipolysis increases serum-free fatty acids, which are metabolised to ketones and cause a metabolic acidosis 

  1. Fluid depletion occurs via osmotic diuresis due to hyperglycaemia, vomiting, and ultimately a reduced oral intake due to a reduced level of consciousness