The recognition and initial management of diabetic acidosis

Diabetic acidosis is a potentially fatal condition. The central problem is insulin deficiency, and the resulting disturbances in carbohydrate, fat and protein metabolism can have disastrous metabolic consequences. It is a preventable condition and usually results from mismanagement of the diabetes, either by the patient or their doctor. The commonest error is the reduction or cessation of insulin by either patient or doctor when confronted by the clinical situation of nausea, vomiting, and anorexia. The major reasons for mismanagement of the patient appear to be a poor understanding of diabetes by patients and some medical practitioners, and their failure to recognize symptoms of poor control and appreciate their significance. Better education of these 2 groups should lead to a fall in the incidence of this medical emergency.