From the Guidelines
Diabetic Ketoacidosis (DKA) is diagnosed based on the presence of hyperglycemia, metabolic acidosis, and ketosis.
Diagnostic Criteria
The diagnostic criteria for DKA include:
- Hyperglycemia: plasma glucose >250 mg/dl, although euglycemic DKA can occur with plasma glucose <200 mg/dl in some cases 1
- Metabolic acidosis: arterial pH <7.3 and serum bicarbonate <15 mEq/l 2, 3, 4
- Ketosis: moderate ketonuria or ketonemia, with the preferred method of monitoring being measurement of beta-hydroxybutyrate (-OHB) in the blood 2 ### Key Considerations
- DKA can be categorized by the severity of the acidosis, with mild, moderate, and severe forms defined by venous pH and bicarbonate levels 5
- The diagnosis of DKA requires the presence of all three criteria: hyperglycemia, metabolic acidosis, and ketosis, although euglycemic DKA can occur in some cases 1
- It is essential to distinguish DKA from other causes of high-anion gap metabolic acidosis, such as lactic acidosis, drug intoxications, and chronic renal failure 4
From the Research
Diagnostic Criteria for Diabetic Ketoacidosis (DKA)
The diagnostic criteria for DKA include:
- A serum glucose level greater than 250 mg per dL 6
- A pH less than 7.3 6, 7, 8
- A serum bicarbonate level less than 18 mEq per L 6, 8
- An elevated serum ketone level 6, 7, 9, 10
- Dehydration 6
- A high anion gap metabolic acidosis 7, 10
- The presence of high urinary or blood ketoacids 7
- Hyperglycaemia, ketonaemia and/or ketonuria, and acidaemia 9
Special Considerations
- Euglycemic DKA, where patients present with blood glucose levels of less than 200 mg/dl, can also occur 8
- The possible etiology of euglycemic DKA includes the recent use of insulin, decreased caloric intake, heavy alcohol consumption, chronic liver disease, and glycogen storage disorders 8
- DKA in pregnancy has also been reported to present with euglycemia 8
- The recent use of sodium glucose cotransporter 2 (SGLT2) inhibitors has shed light on another possible mechanism of euglycemic DKA 8