Diabetic Ketoacidosis Traps

Abstract

Diabetic ketoacidosis often results from an absolute insulin deficiency frequently associated with hypersecretion and hyperglycemic ketogenic hormones (mainly glucagon). The term ketoacidosis seems the most appropriate to describe this syndrome at initial stage and the term ketosis at the predominant metabolic disturbance stage. The classic triad of presentation combines hyperglycemia, metabolic acidosis, and a high concentration of ketones. As with diabetes, the incidence of this condition is increasing with the emergence of new clinical forms. It can be life threatening due to severe clinical and biological disorders and complications associated with treatment (such as cerebral edema, acute respiratory distress, hypokalemia, and hypophosphatemia). However, the observed mortality is low and, for this reason, the admission of patients with diabetic ketoacidosis to intensive care unit (ICU) is still debated. Interestingly, in the absence of randomized trials, there is no data showing the impact of the level of care on mortality. Recommendations on the therapeutic management are regularly updated; however, their effect on clinical outcomes is not clear, because adherence to these recommendations is often poor. The implementation of a “local” protocol may be more effective in decreasing the length of ICU and hospital stay and avoid diagnosis-related errors and/or inappropriate treatment. The objective of this article is to highlight pitfalls in the disease management, particularly in the ICU.