Fifteen to sixty-seven percent of patients with new onset
type 1 diabetes mellitus (T1DM) present in diabetic
ketoacidosis (DKA), of which approximately 79% initially
see their general practitioner. Diabetic ketoacidosis is the
most common cause of diabetes related deaths, mainly due
to cerebral oedema that occurs in 0.4–3.1% of patients.
The aim of this review is to provide information to improve
the early recognition of DKA and to provide guidelines for
the initial management of DKA in the nonspecialist setting.
Recognition of DKA can be improved by increasing the
awareness for early clinical symptoms such as polyuria
and polydipsia. It is important to include urinalysis and
‘fingerprick’ blood glucose and ketone measurements in
the early assessment of patients with suspected T1DM
and known T1DM, particularly if risk factors for DKA are
present, to minimise serious complications and prevent
fatal outcomes. Urgent referral to specialist centres for
suspected new onset T1DM/DKA is required. Specific steps
should be followed to ensure successful initial management
of DKA in the nonspecialist setting before transfer.
The aim of this review is to provide information to improve the early recognition of diabetic ketoacidosis (DKA) and to provide guidelines for the initial management of DKA in the nonspecialist setting. Questions to be answered are:
- Is the patient at risk of DKA?
- Are there clinical symptoms suggestive of DKA?
- What are the initial investigations needed?
- What is the initial therapy?
- Who needs to be contacted?
- What does the specialist treatment include?
- How will the patient be followed up?
Two typical scenarios are described in Case study 1 and 2.
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