From the Guidelines
Laboratory tests for diagnosing and monitoring diabetic ketoacidosis (DKA) should include blood glucose, venous blood gases, electrolytes, blood urea nitrogen (BUN), creatinine, calcium, phosphorous, and urine analysis STAT, as outlined in the protocol for the management of pediatric patients with DKA or HHS 1. When ordering lab tests for DKA, it is essential to consider the diagnostic criteria, which include blood glucose 250 mg/dl, venous pH 7.3, bicarbonate 15 mEq/l, moderate ketonuria or ketonemia 1. Some key lab tests to order include:
- Blood glucose
- Venous blood gases
- Electrolytes (sodium, potassium, chloride, bicarbonate)
- Blood urea nitrogen (BUN)
- Creatinine
- Calcium
- Phosphorous
- Urine analysis It is also important to note that measurement of -OHB in the blood is the preferred method for monitoring DKA, rather than the nitroprusside method, which only measures acetoacetic acid and acetone 1. During therapy, blood should be drawn every 2–4 h for determination of serum electrolytes, glucose, blood urea nitrogen, creatinine, osmolality, and venous pH (for DKA) 1. Criteria for resolution of DKA includes a glucose 200 mg/dl, serum bicarbonate 18 mEq/l, and a venous pH of 7.3 1.
From the FDA Drug Label
Hyperglycemia (too much glucose in the blood) may develop if your body has too little insulin Hyperglycemia can be brought about by any of the following: In patients with type 1 or insulin-dependent diabetes, prolonged hyperglycemia can result in DKA (a life-threatening emergency) The first symptoms of DKA usually come on gradually, over a period of hours or days, and include a drowsy feeling, flushed face, thirst, loss of appetite, and fruity odor on the breath. With DKA, blood and urine tests show large amounts of glucose and ketones.
To diagnose Diabetic Ketoacidosis (DKA), the following lab orders are typically required:
- Blood glucose test: to measure the level of glucose in the blood
- Urine test: to check for the presence of ketones
- Electrolyte panel: to measure the levels of electrolytes such as sodium, potassium, and chloride
- Arterial blood gas (ABG): to measure the level of acidity in the blood
- Complete blood count (CBC): to rule out infection or other conditions that may be contributing to DKA 2
From the Research
DKA Lab Order
To diagnose and manage Diabetic Ketoacidosis (DKA), several lab tests are essential. The following are some of the key lab orders:
- Electrolytes, phosphate, blood urea nitrogen, creatinine, urinalysis, complete blood cell count with differential, A1C, and electrocardiography should be evaluated for all patients diagnosed with DKA to identify causes and complications of DKA 3
- Additional tests to consider include amylase, lipase, hepatic transaminase levels, troponin, creatine kinase, blood and urine cultures, and chest radiography 3
- Measurement of A1C, blood urea nitrogen, creatinine, serum glucose, electrolytes, pH, and serum ketones; complete blood count; urinalysis; electrocardiography; and calculation of anion gap and osmolar gap can differentiate diabetic ketoacidosis from hyperosmolar hyperglycemic state, gastroenteritis, starvation ketosis, and other metabolic syndromes, and can assist in diagnosing comorbid conditions 4
Key Lab Tests
Some of the key lab tests for DKA include: