DKA in Critical Care

• What is DKA? – The triad of hyperglycaemia, ketonaemia, and metabolic acidosis (JBDS 2023 definitions).

• Pathophysiology explained – Insulin deficiency, ketone production, and why potassium is so tricky.

• Clinical features – Polyuria, dehydration, Kussmaul breathing, acetone breath, and red flags for deterioration.

• Investigations – Capillary ketones, blood gases, electrolytes, ECG, and screening for precipitants.

• Management (UK guidelines) – Fluids first, fixed-rate insulin infusion, careful potassium replacement, and always treat the trigger.

• Pitfalls – Starting insulin before fluids, forgetting potassium, dropping glucose too quickly, or missing the underlying cause.

• Case vignette – A young woman with type 1 diabetes presenting in DKA, walking through priorities and pitfalls in real time.

🔑 Key takeaways:

• DKA = fluids first, insulin second, potassium throughout.

• Monitor closely and stick to the JBDS 2023 UK protocol.

• Always identify and treat the precipitating cause.