From the Guidelines
Patients with glycemic ketoacidosis typically present with laboratory results showing blood glucose levels exceeding 250 mg/dL, venous pH below 7.3, bicarbonate levels less than 18 mEq/L, and moderate ketonuria or ketonemia, as well as various electrolyte abnormalities and increased anion gap 1. The diagnostic criteria for DKA include blood glucose levels of 250 mg/dL or higher, venous pH of 7.3 or lower, bicarbonate levels of 15 mEq/L or lower, and moderate ketonuria or ketonemia 1. Some key lab results in patients with glycemic ketoacidosis include:
- Markedly elevated blood glucose levels, often ranging between 300-800 mg/dL
- Metabolic acidosis with a pH below 7.3 and bicarbonate levels less than 18 mEq/L
- Significantly elevated serum ketones with positive results on serum ketone testing
- Increased anion gap (>12 mEq/L) reflecting the accumulation of ketoacids
- Electrolyte abnormalities such as hyponatremia, hyperkalemia or hypokalemia, hypophosphatemia, and hypomagnesemia
- Elevated blood urea nitrogen and creatinine due to dehydration
- Leukocytosis, even in the absence of infection
- Elevated serum osmolality (>290 mOsm/kg)
- Glucosuria and ketonuria on urinalysis However, the most recent study 1 does not provide specific lab results, but rather focuses on the management and treatment of DKA, emphasizing the importance of individualized treatment based on careful clinical and laboratory assessment. The management goals for DKA include restoration of circulatory volume and tissue perfusion, resolution of ketoacidosis, and correction of electrolyte imbalance and acidosis, with treatment approaches including intravenous insulin, fluid replacement, and basal insulin analogs 1.
From the Research
Typical Lab Results in Glycemic Ketoacidosis
The typical lab results in patients with glycemic ketoacidosis include:
- Hyperglycemia (blood glucose greater than 250 mg/dL) 2, 3
- Metabolic acidosis (pH less than 7.3, serum bicarbonate less than 18 mEq/L, anion gap greater than 10 mEq/L) 2, 3
- Elevated serum or urine ketones 2, 3
- High anion-gap metabolic acidosis 4, 5
- Dehydration 2
- Electrolyte imbalances (e.g. sodium, chloride, bicarbonate) 2, 3, 6
- Elevated blood urea nitrogen and creatinine levels 2, 3
- Abnormal urinalysis results (e.g. ketones, glucose) 2, 3, 5
- Abnormal complete blood count and differential results 3
- Elevated A1C levels 2, 3
Euglycemic Diabetic Ketoacidosis
In some cases, patients may present with euglycemic diabetic ketoacidosis, which is characterized by:
- Normal blood glucose levels (less than 250 mg/dL) 4, 5
- Metabolic acidosis (pH less than 7.3, serum bicarbonate less than 18 mEq/L, anion gap greater than 10 mEq/L) 4, 5
- Elevated serum or urine ketones 4, 5
- High anion-gap metabolic acidosis 4, 5
Diagnostic Accuracy of Lab Results
The diagnostic accuracy of lab results for glycemic ketoacidosis is high, with: