Precipitating factors
Factors which may precipitate diabetic ketoacidosis include:
- omission of insulin - commonest cause, failure of compliance with either insulin medication or dietary restrictions must be considered especially in adolescents
- infections – pneumonia, sepsis
- acute medical illnesses e.g. - myocardial infarction, stroke, pancreatitis
- endocrine diseases - acromegaly, Cushing’s syndrome
- stress of recent surgical procedures
- medications e.g. - diuretics, beta-blockers, corticosteroids, antipsychotics, and/or anticonvulsants
- psychological problems, eating disorders
- insulin pump malfunction
- in prepubertal girls, diabetic ketoacidosis may occur at monthly intervals; after menarche, it may occur 2 to 3 days before menstruation
- patients with limited access to medical services
Risk factors for DKA in newly diagnosed cases include
- younger age (<2 yr)
- delayed diagnosis
- lower socioeconomic status
- countries with low prevalence of type 1 diabetes mellitus
Reference:
- JBDS 02 The Management of Diabetic Ketoacidosis in Adults; Association of British Clinical Diabetologists, March 2023
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