Diabetic Ketoacidosis Definition And Epidemiology

In the absence of insulin, diabetic ketoacidosis (DKA) complicates type 1 diabetes mellitus (T1DM). DKA is defined by a triad of hyperglycemia, ketosis, and acidemia and occurs in the absolute or near-absolute absence of insulin. Acidosis is defined as venous pH <7.3 or serum bicarbonate concentrations <18mmol/l. Glucosuria, ketonuria, and ketonemia are typically present. Serum glucose concentrations are typically >13.8mmol/l (250 mg/dl), but may be normal in select cases of partial treatment or pregnancy (1). DKA predominantly affects those with T1DM, but can occur in type 2 diabetes mellitus (T2DM), especially in African-Americans and other minorities who are newly diagnosed (2-4).

DKA accounts for the bulk of morbidity and mortality in children with T1DM. National population-based studies estimate DKA mortality at 0.15% in the United States (4), 0.18-0.25% in Canada (4, 5), and 0.31% in the United Kingdom (6). Rates are higher in adults of age 65 years and older (7)as well as in children with DKA-related cerebral edema (4).

DKA can present in newly diagnosed or pre-existing T1DM. Rates reach 25-67% in those who are newly diagnosed (4, 8, 9). The rates are higher in younger children (<5 years of age) and in children with little access to medical care (4). The risk of DKA among patients with pre-existing diabetes is 1-10% annual per person (10,11). The American Diabetes Association estimates that 5-25% of children with newly diagnosed T2DM have DKA (12).

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