Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Dec 15, 2018; 9(12): 226-229
Published online Dec 15, 2018. doi: 10.4239/wjd.v9.i12.226
Guidelines and controversies in the management of diabetic ketoacidosis – A mini-review
Tasnim Islam, Khalid Sherani, Salim Surani, Abhay Vakil
Tasnim Islam, Khalid Sherani, Salim Surani, Abhay Vakil, Department of Pulmonary and Critical Care, Corpus Christi Medical Center, Corpus Christi, TX 78412, United States
Author contributions: All authors have contributed equally to the conception, design, literature review, drafting and revision of this paper.
Conflict-of-interest statement: None of the authors have any conflict of interest to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author to: Tasnim Islam, MD, Doctor, Resident Physician, Department of Pulmonary and Critical Care, Corpus Christi Medical Center, 3315 S Alameda Street, Corpus Christi, TX 78412, United States.
Telephone: +1-361-8857722 Fax: +1-361-8857726
Received: August 6, 2018
Peer-review started: August 7, 2018
First decision: October 5, 2018
Revised: October 16, 2018
Accepted: November 15, 2018
Article in press: November 16, 2018
Published online: December 15, 2018

Diabetic ketoacidosis (DKA) is a complication seen in patients with both type 1 and type 2 diabetes. Due to its large, growing economic impact with associated morbidity, closer look at proper management is important. Factors involved in appropriate management involves fluid resuscitation, insulin regimen, and electrolyte replacement including types of fluid and insulin treatment. The caveat with generalized protocol is application to special populations such as renal or heart failure patients the sequelae of complications due to pathophysiology of the disease processes. This leads to complications and longer length of stay in the hospital, therefore, possibly increased cost and resource utilization during the hospitalization. This review takes a closer look at current guidelines of DKA management and resource utilization, the drawbacks of current management protocols and the cost associated with it. Therefore, a need for amendment to existing protocol or initiation of a newer guideline that properly manages DKA should incorporate special populations and appropriate regimen of fluid resuscitation, insulin therapy and electrolyte management.

Keywords: Diabetic ketoacidosis management, Fluid resuscitation, Insulin regimen, Electrolyte replacement

Core tip: Diabetic ketoacidosis (DKA) management in both type 1 and type 2 has been in practice for many years, yet the complications and cost associated with it is ever increasing. Treatment with proper resource utilization is the key to appropriate management of DKA, decreased complications and length of stay, therefore, decreased cost of treatment. This review aims to review previous guidelines, choice of therapy, cost associated with it and need for amendments to existing protocols to increase efficacy of DKA treatment, decrease complications and decrease economic burden due to mismanagement of DKA.