Clinical Assessment and Risk Stratification

In the UK and other developed nations, whilst the mortality from DKA remains <1% it is the leading cause of death amongst people under 58 years old with T1DM.[13] Unsurprisingly perhaps, mortality increases with age and with the presence of pre-existing comorbidities The mortality rate is still high at over 40% in some low- and middle-income countries. This high mortality rate illustrates the necessity of early diagnosis and the implementation of effective prevention programmes. Cerebral oedema remains the most common cause of mortality, particularly in young children and adolescents. The main causes of mortality in the adult population include severe hypokalaemia, adult respiratory distress syndrome, and co-morbid states which may have precipitated the DKA such as pneumonia, acute myocardial infarction and sepsis.

Patients who present in DKA may complain of polyuria, polydipsia, weakness, nausea, vomiting (50-80%), coffee-ground haematemesis (25% of vomiting patients) and abdominal pain (30%) [15]. Physical findings are, dry mucous membranes, tachycardia, hypotension, alteration in mental state, sweet smell to the breath and Kussmaul’s respirations.

Fig 1: History and examination may also reveal the underlying cause [7,8,16-18]

Learning bite

In a patient who presents with abdominal pain and vomiting the diagnosis of DKA can easily be missed.

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