Context

DKA is a common presentation to the emergency department.

The presentation can mimic many other disease processes. The ED physician must be able to diagnose, appropriately investigate, initiate treatment and manage complications.

There is a new nationally agreed guideline on the management of DKA, published by the Joint British Diabetes Societies Inpatient Care Group [1].

DKA is defined by this guideline as [1]:

• Ketonaemia > 3.0 mmol/L or significant ketonuria (more than 2+ on standard urine sticks)
• Blood glucose > 11.0 mmol/L or known diabetes mellitus
• Serum venous bicarbonate of < 15.0 mmol/L and/or
• venous pH < 7.3