From the Guidelines
For a 64-year-old female recently discharged after DKA, I would order the following outpatient labs: fasting blood glucose, hemoglobin A1C, basic metabolic panel (BMP), complete blood count (CBC), and urine microalbumin-to-creatinine ratio. The BMP is essential to monitor electrolytes (particularly potassium, sodium, and bicarbonate) and kidney function, as these were likely disturbed during the DKA episode 1. Hemoglobin A1C provides insight into the patient's glycemic control over the past 2-3 months, helping to adjust diabetes management, as outlined in the standards of medical care in diabetes-2021 1. Fasting blood glucose gives current glycemic status, while CBC can identify any underlying infections that might have triggered the DKA. Urine microalbumin screening is important to detect early diabetic nephropathy. I would also consider a lipid panel since cardiovascular risk management is crucial in diabetes, especially given the increased risk of macrovascular and microvascular complications in patients with type 2 diabetes 1. These tests collectively help evaluate the patient's recovery from DKA, assess overall diabetes control, identify any persistent metabolic abnormalities, and guide adjustments to the diabetes treatment regimen to prevent future DKA episodes, in line with the management goals for diabetic ketoacidosis and hyperosmolar hyperglycemic states 1. Additionally, the timing of follow-up and components of care, such as insulin management and provisions for emergency kits, should be considered as per recent clinical practice guidelines 1. It is also important to note that the patient's risk factors, such as age, obesity, and lack of physical activity, should be taken into account when assessing their risk of developing type 2 diabetes and related complications 1. Overall, the management of this patient should prioritize morbidity, mortality, and quality of life outcomes, with a focus on preventing future DKA episodes and managing diabetes-related complications.
From the Research
Laboratory Tests for Diabetic Ketoacidosis (DKA) Follow-up
The following laboratory tests may be ordered for a 64-year-old female patient who was recently released from the emergency room (ER) 1 week ago for DKA:
- Blood glucose level to assess glycemic control 2, 3
- Hemoglobin A1c (HbA1c) to evaluate long-term glycemic control 2, 4, 5
- Electrolyte panel (including sodium, potassium, and bicarbonate) to monitor electrolyte balance 2, 3
- Blood urea nitrogen (BUN) and creatinine to assess renal function 2
- Complete blood count (CBC) to rule out infection or other underlying conditions 2
- Urinalysis to monitor for ketones and assess urinary tract function 2
- Serum ketone levels to monitor for ketosis 2, 3
- Anion gap and osmolar gap calculations to assess for metabolic acidosis 2, 3
Rationale for Laboratory Tests
These laboratory tests are essential for monitoring the patient's glycemic control, electrolyte balance, and renal function, as well as for detecting any potential underlying conditions that may have contributed to the development of DKA 6, 2, 3. Additionally, these tests can help identify patients who may be at risk for recurrent DKA or other complications 4, 5.