Abstract

Diabetic ketoacidosis (DKA) is a life-threatening metabolic emergency of diabetes, defined by the combination of hyperglycemia, ketosis, and metabolic acidosis that arises from effective insulin deficiency and an excess of counter-regulatory hormones. Because nurses are often the first professionals to recognize deterioration, they carry central responsibility for rapid assessment, fluid resuscitation, safe insulin administration, electrolyte and neurological surveillance, and patient education. This review synthesizes contemporary evidence, drawing on the 2024 International Consensus Report and the American Diabetes Association (ADA) 2025 guidance, with an evidence cutoff of 31 December 2025. It examines the diagnostic triad, the pathophysiology cascade, precipitating factors, clinical manifestations, the distinction between classic and euglycemic DKA, essential laboratory monitoring, and the four pillars of medical management: fluid replacement, insulin therapy, electrolyte management, and dextrose administration. Three nursing priorities are described, namely assessment and fluid resuscitation, safe insulin administration, and electrolyte and neurological vigilance, and are applied to an emergency case presentation and a nursing care plan. Discharge planning and sick-day management are presented as preventive medicine. Four messages recur throughout: normalization of blood glucose alone does not indicate that DKA has resolved; potassium must never be administered as an uncontrolled intravenous bolus; insulin must not be stopped independently before prescribed criteria for metabolic resolution are met; and education must be individualized to the patient’s knowledge, regimen, resources, and precipitating factors.

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