From the Guidelines
The diagnostic criteria for diabetic ketoacidosis (DKA) include hyperglycemia with blood glucose typically greater than 250 mg/dL, metabolic acidosis with arterial pH less than 7.3 and serum bicarbonate less than 18 mEq/L, and ketosis with elevated serum ketones or ketonuria. The criteria for DKA diagnosis are based on the presence of these three key components, which are supported by the most recent evidence from the study published in 2010 1. Additional laboratory findings often include:
- Elevated anion gap (usually greater than 10-12 mEq/L)
- Hypokalemia (despite total body potassium depletion)
- Elevated serum osmolality
- Elevated blood urea nitrogen and creatinine due to dehydration Clinical presentation typically includes symptoms of:
- Polyuria
- Polydipsia
- Nausea
- Vomiting
- Abdominal pain
- Altered mental status Kussmaul respirations (deep, rapid breathing) may be present as a compensatory mechanism for metabolic acidosis. It's essential to note that euglycemic DKA can occur, particularly in patients taking SGLT2 inhibitors, where blood glucose may be less than 250 mg/dL despite meeting other criteria. Once DKA is diagnosed, prompt treatment with intravenous fluids, insulin therapy, and electrolyte replacement is crucial to prevent serious complications, including cerebral edema, acute respiratory distress syndrome, and death, as highlighted in the study published in 2004 1. The diagnostic criteria outlined are consistent with the guidelines provided in the studies from 2003 1, 2004 1, and 2004 1, which emphasize the importance of considering hyperglycemia, metabolic acidosis, and ketosis in the diagnosis of DKA.
From the FDA Drug Label
Hyperglycemia, diabetic ketoacidosis, or hyperosmolar coma may develop if the patient takes less Humulin R U-100 than needed to control blood glucose levels 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.
The diagnostic criteria for Diabetic Ketoacidosis (DKA) include:
- Hyperglycemia: high blood glucose levels
- Glycosuria: glucose in the urine
- Ketonuria: ketones in the urine
- Polydipsia: excessive thirst
- Polyuria: excessive urination
- Loss of appetite
- Fatigue
- Dry skin
- Abdominal pain
- Nausea and vomiting
- Compensatory tachypnea: rapid breathing rate 2 2 2
From the Research
Diagnostic Criteria for Diabetic Ketoacidosis (DKA)
The diagnostic criteria for DKA include:
- Serum glucose level greater than 250 mg per dL 3, 4
- pH less than 7.3 3, 4
- Serum bicarbonate level less than 18 mEq per L 3, 4
- Elevated serum ketone level 3, 4
- Dehydration 3
- Anion gap acidosis and ketonuria are also characteristic of DKA 5
Special Considerations
- Euglycemic DKA is a rare complication of diabetes mellitus, characterized by metabolic acidosis, ketosis, and blood glucose levels < 250 mg/dL 6
- The prevalence of euglycemic DKA is increasing with the popularity of ketogenic (low-carbohydrate) diets 6
- Beta-hydroxybutyrate is a better measurement of the degree of ketosis than serum ketones 4