A number of pathophysiological processes occur in DKA:
-
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
-
Enhanced lipolysis increases serum-free fatty acids, which are metabolised to ketones and cause a metabolic acidosis
-
Fluid depletion occurs via osmotic diuresis due to hyperglycaemia, vomiting, and ultimately a reduced oral intake due to a reduced level of consciousness
