Protocolo de Cetoacidose Diabética: atualizações e padronização do atendimento

Abstract

Introduction: Diabetes mellitus is a chronic metabolic condition characterized by insulin deficiency and persistent hyperglycemia, which may progress to severe acute complications such as diabetic ketoacidosis (DKA). This metabolic emergency results from an absolute or relative lack of insulin, leading to hyperglycemia, acidosis, and ketonemia. Objective: To describe, based on current evidence, the diagnostic and therapeutic management of diabetic ketoacidosis in the hospital setting, aiming to standardize clinical practice. Methodology: A narrative review of the scientific literature was conducted through searches in PubMed Central, SciELO, and UpToDate databases, covering the period from 2022 to 2025. Articles in Portuguese and English addressing clinical, laboratory, therapeutic aspects, and institutional protocols related to DKA were included. Results and Discussion: After screening 5,847 articles, 12 studies were selected, including updated national and international guidelines. Evidence indicates that treatment should prioritize vigorous hydration with isotonic solutions, continuous intravenous insulin infusion (0.1 U/kg/h), electrolyte replacement guided by serial laboratory tests, and close monitoring of potassium levels. The use of bicarbonate should be limited to cases with pH <6.9. Updated criteria emphasize diagnosis based on ketonemia ≥3 mmol/L, pH <7.3, and bicarbonate <15 mEq/L. Conclusion: DKA management requires a systematic approach, careful monitoring, and constant updating of clinical protocols according to recent guidelines. The standardization of therapeutic conduct reduces complications, improves prognosis, and strengthens evidencebased medical practice.