Background 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.
Objective 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.
Discussion 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.
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