Diabetic Ketoacidosis Anaesthesia

Abstract

DKA is a potentially life threatening complication of Diabetes Mellitus. An understanding of the pathophysiology of the conditions aids appropriate treatment. Initial assessment must involve a rapid assessment of Airway, Breathing and Circulation and obtaining sufficient intravenous access. Initial investigations are aimed at confirming the diagnosis and identifying underlying causes. The diagnosis of DKA requires a blood sugar >14.0 mmol/l, positive urinary or plasma ketones , an arterial pH < 7.3 and serum bicarbonate of < 18mmol/l. The basic principles of DKA management include rapid restoration of adequate circulation and perfusion with isotonic intravenous fluids, gradual rehydration and restoration of depleted electrolytes, insulin to reverse ketosis and hyperglycaemia and regular monitoring of clinical signs and laboratory tests to detect and treat complications. A target rate of correction of hyperglycaemia is a drop of blood glucose by 3 – 4 mmol/l/hr. Acute cerebral oedema is a potential complication possibly due to excessive fluid therapy or too rapid a fall in blood glucose. Early signs of the development of this potentially fatal complication include headache, irritation and confusion. Prompt recognition and appropriate management may improve prognosis.