Diabetic ketoacidosis: Pathophysiology and alterations of the internal milieu

Abstract

Diabetic ketoacidosis is a frequent complication in the patient with diabetes mellitus, especially in type 1. The alterations in the normal functioning of the α and β pancreatic cells that occur in this disease, results in insulinopenia and hyperglucagonemia. This new metabolic state augments lipid catabolism, which in turn produces ketogenic precursors. The imbalance between hepatic output and peripheral oxidation of the resulting ketone bodies produces a significant increase in the ketonemia and disrupts the homeostasis of the internal milieu. In this review, we will describe the pathophysiology of the hormonal alterations in diabetic ketoacidosis and their impact in the acid base and electrolyte balance.