What are the laboratory findings indicative of Diabetic Ketoacidosis (DKA)?

From the Guidelines

Diabetic ketoacidosis (DKA) is characterized by key laboratory findings including elevated blood glucose, decreased arterial pH, elevated anion gap, and positive serum ketones, with beta-hydroxybutyrate being the predominant ketone, as indicated by the most recent guidelines 1.

Key Laboratory Findings

• Blood glucose is typically elevated above 250 mg/dL, often ranging from 300-800 mg/dL
• Arterial pH is decreased (<7.30), indicating acidosis, with bicarbonate levels below 18 mEq/L
• Anion gap is elevated (>10-12 mEq/L) due to the accumulation of ketone bodies
• Serum ketones are positive, with beta-hydroxybutyrate being the predominant ketone, and should be measured in blood for diagnosis and monitoring of DKA 1

Electrolyte Abnormalities and Other Findings

• Electrolyte abnormalities include hyponatremia, hyperkalemia (initially, despite total body potassium depletion), and hypophosphatemia
• Renal function tests often show elevated BUN and creatinine due to dehydration
• Complete blood count may reveal leukocytosis, even without infection
• Serum osmolality is typically elevated (>290 mOsm/kg)
• Urinalysis shows glucosuria and ketonuria
• Arterial blood gases reveal metabolic acidosis with respiratory compensation (low pCO2)

Diagnosis and Monitoring

• DKA should be distinguished from other causes of high-anion gap metabolic acidosis, including lactic acidosis, ingestion of certain drugs, and chronic renal failure 1
• Measurement of blood lactate, serum salicylate, and blood methanol level can be helpful in diagnosing other causes of high-anion gap metabolic acidosis 1
• Specific measurement of beta-hydroxybutyrate in blood should be used for diagnosis of DKA and may be used for monitoring during treatment of DKA 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: Omitting your insulin or taking less than your doctor has prescribed. 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.

DKA findings on lab work include:

• Large amounts of glucose in the blood
• Presence of ketones in the blood and urine These findings are indicative of Diabetic Ketoacidosis (DKA), a life-threatening emergency that requires immediate medical attention 2.

From the Research

DKA Findings on Lab Work

• The diagnosis of Diabetic Ketoacidosis (DKA) is typically confirmed by the presence of hyperglycemia, metabolic acidosis, and elevated serum or urine ketones 3, 4, 5, 6.
• Lab work findings for DKA may include:
  • Hyperglycemia (blood glucose greater than 250 mg/dL) 3, 4, 6.
  • Metabolic acidosis (pH less than 7.3, serum bicarbonate less than 18 mEq/L, anion gap greater than 10 mEq/L) 3, 4, 5, 6.
  • Elevated serum or urine ketones 3, 4, 5, 6.
  • Electrolyte imbalances, such as sodium, potassium, and phosphate abnormalities 3, 4.
  • Elevated blood urea nitrogen and creatinine levels 3, 4.
  • Abnormal complete blood cell count with differential 3, 4.
  • Elevated A1C levels 3, 4.
• It's worth noting that some cases of DKA may present with a normal anion gap, which can make diagnosis more challenging 7.
• Additionally, euglycemic DKA, which is characterized by normal or only slightly elevated blood glucose levels, can also occur, particularly in patients taking sodium-glucose cotransporter-2 inhibitors 3.