A patient who has been treated for diabetic ketoacidosis is at risk for relapse if not properly managed.

Patient selection: diabetic ketoacidosis after discontinuation of initial management


The occurrence of a relapse is indicated by an increasing anion gap, often preceded by a rise in the blood glucose concentration.


Risk factors associated with a relapse of ketoacidosis:

(1) discontinuation of the insulin infusion early (before all of the endpoints have been reached)

(2) no or inadequate coverage by a long-acting insulin

(3) persistent acidosis

(4) inadequate oral intake to meet caloric needs

(5) ongoing systemic inflammation

(6) ongoing severe insulin resistance

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