There are few things in medicine that get your adrenaline pumping faster than seeing a patient roll into the ER with fruity breath, Kussmaul breathing, and a pH that looks more like a hemoglobin level. 😅
Yes, I’m talking about Diabetic Ketoacidosis (DKA) — the metabolic chaos that loves showing up uninvited. If you’re prepping for FCPS, MRCP, or just trying to survive another night on call, remember the 5 I’s of DKA Precipitants. It’s a classic. It’s reliable. And it actually helps in real life — unlike those “zebra” mnemonics that never show up outside textbooks.
The 5 I’s Mnemonic — DKA Precipitants at a Glance
| Mnemonic | Meaning | Clinical Clue |
|---|---|---|
| Infection | Pneumonia, UTI, sepsis, etc. | Fever, leukocytosis, CRP on fire — basically anything that makes the body panic |
| Ischaemia | Cardiac, mesenteric | Chest pain, ECG changes, troponins — or sudden severe abdominal pain 😖 |
| Infarction | Stroke, MI, etc. | Focal neuro deficits, ST-elevation — or both 🙃 |
| Ignorance | Poor insulin compliance | “Forgot my insulin, doc” or “I ran out 2 weeks ago” — classic lines 🙄 |
| Intoxication | Alcohol, drug use | Anion gap party: ketosis, confusion, liver enzymes doing gymnastics |
🩺 My Take — Straight from the Wards of Quetta
You’d be surprised how often the cause of DKA isn’t a fancy diagnosis but a forgotten insulin pen. Just last week, a 26-year-old male from Mashkhel showed up with vomiting and altered sensorium. Glucose? 36 mmol/L. pH? 7.08.
Initially, I thought sepsis. But turns out, he’d been relying solely on prayer and goat milk 🐐 for the past week instead of insulin. “Mujhe laga Ramadan mein theek ho jaunga, Doctor Saab.” 🙃
He walked out fine after fluids, insulin, and a solid chat with Dr. Behroz Rahim, our psychiatrist, who reminded us that metabolic control has a strong psychosocial side too.
We hope that you find this blogpost useful. Happy learning! 🙂
Author: Dr. Aurangzaib Qambrani
Qualifications: MBBS, PLAB, MRCP-UK
Hospital: Sheikh Khalifa Bin Zayed Hospital, Quetta
Departments: General Medicine | Gastroenterology | Cardiac Care Unit
