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:
- Infection: Look for potential infectious foci (pneumonia, bacteremia, UTI etc.).
- Ischemia: Such as ACS, critical limb ischemia or ischemic bowel.
- Intoxication: ETOH, MDMA, Cocaine, Methamphetamine etc.
- Infraction/ Intolerance: Patient not taking their insulin.
- Iatrogenic: Secondary to medications (i.e steroids) or surgeries.
- Initial Presentation: First time presentation typically in young children.
- Impregnation: Increased metabolic demands of pregnancy make precipitate an episode of DKA.
*NOTE: These causes are also precipitants for Hyperosmolar Hyperglycemic State (HHS).
REFERENCES
- Umpierrez GE, Kitabchi AE. Diabetic ketoacidosis: risk factors and management strategies. Treat Endocrinol. 2003;2(2):95-108.