precipitating factors

Last reviewed 01/2018

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 (2)

Reference:

• (1) Gosmanov AR, Gosmanova EO, Dillard-Cannon E. Management of adult diabetic ketoacidosis. Diabetes Metab Syndr Obes. 2014;7:255-64. 
• (2) Wolfsdorf JI et al. Diabetic ketoacidosis and hyperglycemic hyperosmolar state. Pediatr Diabetes. 2014;15 Suppl 20:154-79.