From the Guidelines
Diabetic ketoacidosis (DKA) is diagnosed through a combination of clinical symptoms and laboratory findings, with the most recent guidelines recommending the measurement of beta-hydroxybutyrate in blood for diagnosis and monitoring 1. The diagnosis of DKA requires three key elements:
- Hyperglycemia (blood glucose typically >250 mg/dL)
- Metabolic acidosis (arterial pH <7.3 and serum bicarbonate <18 mEq/L)
- Ketosis (elevated serum and urine ketones) Patients typically present with symptoms including:
- Excessive thirst
- Frequent urination
- Nausea
- Vomiting
- Abdominal pain
- Weakness
- Confusion
- A fruity breath odor Initial evaluation should include:
- A comprehensive metabolic panel to assess electrolytes (particularly potassium, sodium, and phosphate), blood glucose, blood urea nitrogen, and creatinine
- An arterial blood gas analysis to determine the severity of acidosis
- Serum ketones, particularly beta-hydroxybutyrate, which should be measured as they are more sensitive than urine ketones 1 Additional tests include:
- Complete blood count
- Urinalysis
- Electrocardiogram to assess for complications or precipitating factors Point-of-care testing can provide rapid results for glucose and ketones, allowing for prompt treatment initiation. The diagnosis of DKA is critical as it represents a medical emergency requiring immediate intervention with insulin therapy, fluid resuscitation, and electrolyte replacement to prevent potentially life-threatening complications, as recommended by recent guidelines 1.
From the FDA Drug Label
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. Early signs of diabetic ketoacidosis include glycosuria and ketonuria Polydipsia, polyuria, loss of appetite, fatigue, dry skin, abdominal pain, nausea and vomiting and compensatory tachypnea come on gradually, usually over a period of some hours or days, in conjunction with hyperglycemia and ketonemia.
Diabetic ketoacidosis (DKA) is diagnosed based on the presence of high blood glucose levels and ketones in the blood and urine, along with symptoms such as:
- Drowsy feeling
- Flushed face
- Thirst
- Loss of appetite
- Fruity odor on the breath
- Polydipsia (excessive thirst)
- Polyuria (frequent urination)
- Fatigue
- Dry skin
- Abdominal pain
- Nausea and vomiting
- Compensatory tachypnea (rapid breathing) 2 2
From the Research
Diagnosis of Diabetic Ketoacidosis (DKA)
Diabetic ketoacidosis (DKA) is diagnosed based on a combination of clinical symptoms, laboratory tests, and physical examination. The key diagnostic criteria for DKA include:
- Hyperglycemia (blood glucose greater than 250 mg/dL) [(3,4,5)]
- 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 [(3,4,5,6,7)]
Laboratory Tests
Laboratory tests that are typically ordered to diagnose and manage DKA include:
- Electrolytes (sodium, potassium, chloride) [(3,4,5)]
- Phosphate and magnesium levels [(3,5)]
- Blood urea nitrogen (BUN) and creatinine [(3,4)]
- Complete blood count (CBC) with differential [(3,4)]
- Urinalysis [(3,4)]
- A1C [(3,4)]
- Electrocardiography (ECG) [(3,4)]
- Amylase and lipase levels 3
- Hepatic transaminase levels 3
- Troponin and creatine kinase levels 3
- Blood and urine cultures 3
- Chest radiography 3
Clinical Symptoms
Common clinical symptoms of DKA include:
- Polyuria and polydipsia [(3,4)]
- Nausea and vomiting [(3,4)]
- Abdominal pain [(3,4)]
- Weight loss [(3,4)]
- Severe fatigue [(3,4)]
- Dyspnea [(3,4)]
- Preceding febrile illness [(3,4)]