Dawaa Reference

emergency

Diabetic Ketoacidosis (Emergency Referral)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources2 sources

Adult Diabetic Ketoacidosis - StatPearls, updated 30 November 2025 - https://www.ncbi.nlm.nih.gov/books/NBK560723/ · No dose - referral pathway, no medicine given in primary care

Verified against2 documents
  • Adult Diabetic Ketoacidosis - StatPearls, updated 30 November 2025 - https://www.ncbi.nlm.nih.gov/books/NBK560723/
  • No dose - referral pathway, no medicine given in primary care

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (5)

  • Excess hunger, urination, and thirst can signal underlying hyperglycemia [hyperglycaemia]
  • Reduced urine output, a dry mouth, and decreased sweating point to worsening dehydration [dehydration · dry mouth · sweating]
  • Loss of appetite, nausea, vomiting, abdominal pain, and weight loss are commonly reported [abdominal pain · nausea · poor appetite · vomiting · weight loss]
  • Fever, cough, or urinary complaints may appear when an infection has triggered the episode [cough · fever]
  • Headache or confusion can signal evolving cerebral edema [confusion · headache · oedema]

Signs — what you find (8)

  • Vital signs often show a fast heart rate and rapid breathing [tachycardia · tachypnoea]
  • Fever or low body temperature may be seen when an infection underlies the episode [fever · hypothermia]
  • Low blood pressure can occur and marks a more severe course [hypotension]
  • Deep, labored, rapid breathing (Kussmaul respirations) may be seen [tachypnoea]
  • A fruity breath odor from acetone may be noticeable on exam
  • Poor capillary refill, reduced skin turgor, and dry mucous membranes reflect dehydration [dehydration]
  • Abdominal tenderness may be found on exam [abdominal tenderness]
  • Altered mental status, drowsiness, and focal neurologic deficits mark the most severe cerebral edema [drowsiness · oedema]

Tests (11)

  • Diagnosis requires glucose above 250 mg/dL, arterial pH under 7.3, bicarbonate under 15 mEq/L, and ketonemia or ketonuria
  • An anion gap over 14 to 15 mEq/L marks an elevated anion-gap metabolic acidosis
  • Glucose can be only mildly raised, under 300 mg/dL, in those prone to hypoglycemia such as insulin or SGLT2-inhibitor users
  • Most patients show a raised white cell count even without an infection
  • Measured serum sodium reads falsely low and must be corrected for the glucose level
  • Serum potassium is typically raised even though whole-body stores are depleted
  • Serum phosphate may look elevated despite overall body phosphate depletion
  • The 3-beta-hydroxybutyrate to acetoacetate ketone ratio rises from a normal 1:1 up to as much as 10:1
  • ECG changes such as peaked T waves point to hyperkalemia, while flattened T waves with a U wave point to hypokalemia
  • A chest x-ray may be obtained to exclude pulmonary consolidation
  • CT of the brain can identify significant cerebral edema when it is suspected

If not this — what else fits (10)

  • Hyperosmolar hyperglycemic nonketotic syndrome is on the differential
  • Starvation ketosis is a differential to consider
  • Myocardial infarction is on the differential list
  • Pancreatitis is a differential to consider
  • Alcoholic ketoacidosis is a differential to rule out
  • Lactic acidosis is a differential to consider
  • Sepsis is a differential to consider
  • Toxicologic exposure such as ethylene glycol, methanol, paraldehyde, or salicylate is a differential
  • Diabetic medication overdose is a differential to consider
  • Uremia is a differential to consider

SourceStatPearls "Adult Diabetic Ketoacidosis" - disease-level clinical article

Presentation findings are traced to the source above.

1

NO DRUG THERAPY IN PRIMARY CARE (RECOGNITION & REFERRAL)

1st line
Adult dose and duration

Emergency admission, now. Thirst, polyuria and weight loss progressing to vomiting, abdominal pain, deep sighing (Kussmaul) breathing and a fruity smell on the breath. Diagnosis is glucose above 250 mg/dL, arterial pH below 7.3, bicarbonate below 15 mEq/L, and ketones in blood or urine. Check a capillary glucose and ketones if you can, but a patient who looks like this goes to hospital whether or not you can measure them. - Refer, with advice

Paediatric dose

Children decompensate faster and are at risk of cerebral oedema during treatment. Emergency transfer; do not attempt rehydration protocols in the clinic.

Dose source

No dose - referral pathway, no medicine given in primary care

Cautions
  • HOSPITAL ONLY. StatPearls: intravenous insulin by continuous infusion is the standard of care, with hourly glucose monitoring. There is no outpatient version of this.
  • DO NOT give insulin before potassium is known. StatPearls requires a potassium of at least 3.5 mmol/L before insulin is started - giving insulin first can cause fatal hypokalaemia.
  • It can be the FIRST presentation of diabetes. A previously well young person with these symptoms has new type 1 diabetes until proved otherwise - see [Type 1 Diabetes].
  • Infection, missed insulin doses, corticosteroids, thiazides and SGLT-2 inhibitors are the common precipitants. SGLT-2 inhibitors can produce ketoacidosis with a near-normal glucose.
  • Abdominal pain in DKA is often taken for a surgical abdomen. Check ketones before referring the pain instead of the patient.

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.