We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Article |

Treatment of Diabetic Ketoacidosis

Steven N. Levine, MD; Joseph E. Loewenstein, MD
Arch Intern Med. 1981;141(6):713-715. doi:10.1001/archinte.1981.00340060021006.
Text Size: A A A
Published online


Three major changes have occurred in the treatment of diabetic ketoacidosis during the past decade: (1) a trend toward continuous intravenous (IV) infusion of insulin, (2) a trend toward the use of lower doses of insulin, and (3) the reintroduction of phosphate replacement. These changes are based on sound theoretical considerations, but their effects on mortality and morbidity are still being evaluated. Despite any changes, intelligent treatment of diabetic ketoacidosis still requires an understanding of the underlying pathophysiology.

PATHOGENESIS OF DIABETIC KETOACIDOSIS  There are two major abnormalities in diabetic ketoacidosis—metabolic acidosis and hyperglycemia. Each of these is caused by insulin deficiency.

Metabolic Acidosis  An understanding of fatty acid and ketone metabolism is required to understand the pathogenesis of acidosis.1,2 Fatty acids are stored as triglycerides within fat cells. Fatty acids released by fat cells are taken up and metabolized by the liver, and ketone bodies (acetoacetic acid, β-hydroxybutyric acid,


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.