From the Guidelines
Diabetic Ketoacidosis (DKA) is diagnosed based on three key laboratory findings: hyperglycemia, ketosis, and metabolic acidosis, specifically indicated by a blood glucose level greater than 250 mg/dL, the presence of ketones in the blood and urine, and a low arterial pH (<7.30) with decreased serum bicarbonate (<18 mEq/L) 1.
Key Laboratory Findings for DKA
- Hyperglycemia: blood glucose level greater than 250 mg/dL
- Ketosis: presence of ketones in the blood (beta-hydroxybutyrate >3 mmol/L) and urine
- Metabolic acidosis: low arterial pH (<7.30) with decreased serum bicarbonate (<18 mEq/L)
Additional Laboratory Abnormalities
- Elevated serum osmolality
- Increased blood urea nitrogen (BUN) and creatinine due to dehydration
- Leukocytosis
- Electrolyte disturbances, particularly potassium abnormalities
- Initially, serum potassium may be normal or elevated despite total body potassium depletion due to the acidosis-driven shift of potassium from intracellular to extracellular spaces
- Phosphate and magnesium levels may also be decreased
Diagnosis and Management
The diagnosis of DKA is based on the presence of these laboratory findings, and management goals include restoration of circulatory volume and tissue perfusion, resolution of hyperglycemia, and correction of electrolyte imbalance and acidosis 1.
Recent Guidelines
Recent guidelines recommend individualization of treatment based on a careful clinical and laboratory assessment, and the use of continuous intravenous insulin in critically ill and mentally obtunded patients with DKA or hyperosmolar hyperglycemic state 1.
From the Research
Diabetic Ketoacidosis (DKA) Lab Values
The lab values that indicate Diabetic Ketoacidosis (DKA) include:
- Elevated blood glucose levels, typically greater than 250 mg/dL 2, 3
- Presence of high urinary or blood ketoacids 4
- High anion gap metabolic acidosis, with a pH less than 7.3 and serum bicarbonate level less than 18 mEq/L 4, 2, 3
- Dehydration 2
- Elevated serum ketone level 2
Euglycemic Diabetic Ketoacidosis (EDKA) Lab Values
In some cases, DKA can occur with normal or low blood glucose levels, known as Euglycemic Diabetic Ketoacidosis (EDKA). The lab values that indicate EDKA include:
- Normal or low blood glucose levels, typically less than 250 mg/dL 5, 3, 6
- Presence of high urinary or blood ketoacids 5, 3, 6
- High anion gap metabolic acidosis, with a pH less than 7.3 and serum bicarbonate level less than 15 mEq/L 3, 6
- Elevated serum ketone level 5, 3, 6
Key Lab Tests
Key lab tests used to diagnose DKA and EDKA include: