From the Guidelines
The resolution of diabetic ketoacidosis (DKA) should be assessed using blood glucose concentration, serum bicarbonate, and venous pH, as these are the most reliable indicators of DKA resolution, according to the most recent and highest quality study 1. When assessing the resolution of DKA, it is essential to monitor the following key components:
- Blood glucose levels: should decrease by 50-75 mg/dL per hour with insulin therapy, reaching a target of 150-200 mg/dL
- Serum bicarbonate: should increase from its initially low level (<18 mEq/L) toward normal range (22-28 mEq/L)
- Venous pH: should normalize as ketoacids are cleared, with a target of 7.3 or higher These components are crucial in determining the resolution of DKA, as they provide a comprehensive picture of the patient's metabolic state. The use of serum ketones, specifically beta-hydroxybutyrate, is also recommended for monitoring DKA treatment, as it is the predominant ketone body in DKA 1. However, blood glucose concentration, serum bicarbonate, and venous pH are the primary indicators of DKA resolution, and should be prioritized in clinical practice. In contrast, measured serum sodium and corrected serum sodium are not directly relevant to the assessment of DKA resolution, and should not be used as primary indicators. By focusing on blood glucose concentration, serum bicarbonate, and venous pH, clinicians can ensure that patients with DKA receive timely and effective treatment, and can minimize the risk of complications and morbidity.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Assessing Resolution of Diabetic Ketoacidosis
To assess the resolution of diabetic ketoacidosis (DKA), several components should be considered:
- Serum ketones: Measurement of serum ketone levels is crucial in diagnosing and monitoring DKA, as elevated ketone levels are a hallmark of the condition 2.
- Blood glucose concentration: Monitoring blood glucose levels is essential in managing DKA, as hyperglycemia is a key feature of the condition 3, 4.
- Venous pH and anion gap: These parameters are used to assess acid-base status and monitor the resolution of DKA 5.
- Serum bicarbonate: This parameter can be used to predict DKA resolution, with a cut-off value of >15 mmol/L having 76% sensitivity and 85% specificity 5.
Components Not Recommended
- Corrected serum sodium: While serum sodium levels are important in managing DKA, corrected serum sodium is not specifically recommended as a component for assessing resolution of DKA.
- Measured serum sodium: Similarly, measured serum sodium is not a primary component for assessing DKA resolution, although it may be monitored as part of overall electrolyte management.