Pathophysiology and treatment in Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is the presence of metabolic acidosis with an elevated anion gap, ketonemia or ketonuria, with or without hyperglycemia, in the context of a prior diagnosis of diabetes mellitus (DM) or a new diagnosis of DM. In this case, it is caused by a relative or absolute insulin deficiency, leading to ketogenesis, lipolysis, lipotoxicity, and metabolic acidosis. There is a vast amount of literature—articles, reports, books, journals, and many other sources—focused on advances in the treatment and pathophysiology of DM and its decompensated states, primarily diabetic ketoacidosis. However, no ideal study has yet been established to fully explain the pathophysiology, triggers, and, of course, optimal treatment without generating controversy. Therefore, the objective of this review is to analyze, describe, and discuss updates on the pathophysiology and treatment of DKA in a precise and concise manner, in order to support healthcare personnel in managing patients with this complication. Decompensated DM can have a broad pathophysiology, so ideal treatments must be considered to avoid short- and long-term complications, including ketoacidosis, as well as certain variations in clinical presentation, such as in the case of euglycemic ketoacidosis