DIABETIC-KETOACIDOSIS

The availability of insulin has dramatically influenced the prognosis of patients with insulin-requiring diabetes. The mortality rate of patients presenting with severe diabetic ketoacidosis has fallen to 0.5-15% in the best centres. A higher figure, however, still remains in less specialised units and in elderly patients it may be as high as 50%. The vast majority of these deaths are preventable. A better understanding of the aetiology and pathogenesis of severe diabetic ketoacidosis must form a basis for improved patient management. An integrated on-going diabetic care programme is essential to reduce even further the incidence of this life-threatening situation. Next to hypoglycaemia, severe diabetic ketoacidosis is the most frequent diabetic emergency. Infection, arterial thrombosis and shock are the 3 major determinants of death in this condition. Prompt diagnosis and treatment with early recognition of complicating factors followed by appropriate remedial action is essential to a favourable outcome. Basic management consists primarily of adequate fluid and electrolyte replacement, correction of the metabolic derangement employing low-dose insulin regimes and treatment of any precipitating cause. Frequent monitoring of both clinical and biochemical parameters is essential throughout. Other actions needing consideration may include the use of continuous stomach aspiration in the conscious or semi-conscious patient, bladder catheterisation if no urine is passed, oxygen and low-dose heparinisation. All well-educated, insulin-dependent, diabetic patients should be able to avoid any episodes of serious diabetic ketoacidosis throughout their life. © 1979 Springer-Verlag.