Diabetic Ketoacidosis and Urinary Function

Pathophysiology of DKA

DKA is characterized by insulin deficiency and elevated counterregulatory hormones leading to hyperglycemia, ketosis, and acidosis, resulting in osmotic diuresis and increased urinary output 3
The hyperglycemia in DKA causes osmotic diuresis, not urinary retention, as glucose spills into the urine when blood glucose exceeds the renal threshold 2, 4
This osmotic diuresis leads to significant fluid losses, typically 6-9 liters in adults with DKA 1, 2
The polyuria is a hallmark clinical feature of DKA, along with polydipsia and polyphagia 3, 5

Classical clinical picture of DKA includes polyuria, not urinary retention 3, 5
Laboratory findings show hyperglycemia, metabolic acidosis, and ketonemia/ketonuria 1, 2
Urinalysis typically shows glycosuria and ketonuria 2, 4

Fluid therapy is the cornerstone of DKA management, with initial fluid therapy directed toward expansion of intravascular volume and restoration of renal perfusion 2, 6
Isotonic saline is typically infused at 15-20 ml/kg/h during the first hour to correct dehydration 2, 7
Monitoring urine output is important during DKA management to assess renal function and fluid status 8