7 I’s of DKA: Causes Mnemonic

When a patient presents with DKA, it is important to try to elucidate the cause. An easy way to remember those causes are the 7 I’s of DKA:

1. Infection: Look for potential infectious foci (pneumonia, bacteremia, UTI etc.).
2. Ischemia: Such as ACS, critical limb ischemia or ischemic bowel.
3. Intoxication: ETOH, MDMA, Cocaine, Methamphetamine etc. 
4. Infraction/ Intolerance: Patient not taking their insulin. 
5. Iatrogenic: Secondary to medications (i.e steroids) or surgeries.
6. Initial Presentation: First time presentation typically in young children. 
7. Impregnation: Increased metabolic demands of pregnancy make precipitate an episode of DKA.

*NOTE: These causes are also precipitants for Hyperosmolar Hyperglycemic State (HHS).

REFERENCES

1. Umpierrez GE, Kitabchi AE. Diabetic ketoacidosis: risk factors and management strategies. Treat Endocrinol. 2003;2(2):95-108.