From the Guidelines
Diabetic ketoacidosis (DKA) is diagnosed when a patient has a blood glucose level greater than 250 mg/dL, venous pH less than 7.3, bicarbonate level less than 15 mEq/L, and moderate ketonuria or ketonemia, as stated in the most recent and highest quality study 1.
Diagnostic Criteria
The diagnostic criteria for DKA include:
- Blood glucose level greater than 250 mg/dL
- Venous pH less than 7.3
- Bicarbonate level less than 15 mEq/L
- Moderate ketonuria or ketonemia These criteria are based on the most recent study from 2004 1, which provides the most up-to-date and accurate information on DKA diagnosis.
Importance of Accurate Diagnosis
Accurate diagnosis of DKA is crucial, as it is a medical emergency that requires immediate attention to prevent significant morbidity and mortality. The underlying pathophysiology of DKA involves insulin deficiency, leading to increased gluconeogenesis, decreased glucose utilization, and increased lipolysis with subsequent ketone body formation, resulting in characteristic metabolic derangements.
Clinical Presentation
Clinical presentation of DKA typically includes symptoms of hyperglycemia, dehydration, Kussmaul respirations, fruity breath odor from acetone, and altered mental status ranging from mild confusion to coma. Additional laboratory findings often include elevated serum osmolality, elevated potassium, elevated BUN and creatinine indicating dehydration, and leukocytosis even in the absence of infection.
Monitoring and Management
Monitoring and management of DKA involve frequent assessment of serum electrolytes, glucose, blood urea nitrogen, creatinine, osmolality, and venous pH, as well as fluid replacement and insulin therapy, as outlined in the study 1.
From the Research
Diagnostic Criteria for DKA
The diagnostic criteria for Diabetic Ketoacidosis (DKA) include:
- Hyperglycemia (blood glucose greater than 250 mg/dL) 2, 3, 4
- Metabolic acidosis (pH less than 7.3, serum bicarbonate less than 18 mEq/L, anion gap greater than 10 mEq/L) 2, 3, 4
- Elevated serum or urine ketones 2, 3, 5, 4 Alternatively, the diagnosis of DKA can be confirmed when all three of the following criteria are present:
- 'D', either elevated blood glucose levels or a family history of diabetes mellitus
- 'K', the presence of high urinary or blood ketoacids
- 'A', a high anion gap metabolic acidosis 5
Laboratory Tests
Laboratory tests that can help diagnose DKA and identify underlying causes and complications include:
- Electrolytes, phosphate, blood urea nitrogen, creatinine, urinalysis, complete blood cell count with differential, A1C, and electrocardiography 2, 3
- 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 2
Note
Note that study 6 is not relevant to the diagnostic criteria for DKA.