STM Article Repository

Diabetic ketoacidosis (DKA) is a condition of diabetes mellitus that is life-threatening and occurs whenever blood sugar levels rise, ketones are produced and the body begins to get acidosis. The issue of timely and appropriate management is critical to avoid the development of fatal conditions. Over the years, two main approaches to DKA management have emerged: slow and fast. The conventional way of treating DKA attacks is through a gradual improvement of the hyperglycemia and metabolic abnormalities, which may span up to 24 to 48 hours. This procedure mainly involves intravenous fluid replenishment, insulin infusion, and the correction of electrolyte imbalance. However, this method has certain shortcomings. The disadvantage includes the long time that the patient has to stay in hospital, which results in extra costs for treatment and inconvenience for the person. Moreover, overcorrection may heighten the chance of cerebral edema, a rare but fatal issue that may occur during or after DKA treatment. In the last few years, there has been a lot of attention around fast management methods which are aimed at getting rid of excessive blood sugar levels as well as other abnormalities within a shorter time range typically of 6 to 12 hours. Aggressive approaches to quick control include higher insulin infusion rates, intensive fluid resuscitation, and close checks on electrolytes, acid-base status, and other parameters. Supporters of fast treatment say that it shortens the length of hospitalization, makes it less costly, and minimizes brain edema, which is one of the complications. Nevertheless, the negative impacts may involve the incidence of hypoglycemia, hypokalemia, and rebound hyperglycemia by rapid correction. Many studies have demonstrated that the therapeutic and medicinal efficacy and safety levels of both slow and rapid management approaches to DKA are almost similar. In some instances, trials may reveal similar outcomes of the two strategies, on the other hand, conflicting results have also been reported. This review shall reflect on both the slow and fast management of diabetic ketoacidosis and enlist the ways that have been decided as per the guidelines to help manage the patients on urgent basis in the emergency room.