From the Guidelines
Diabetic ketoacidosis (DKA) is diagnosed when a patient has a blood glucose level greater than 250 mg/dL, a venous pH of 7.3 or less, a serum bicarbonate level less than 18 mEq/L, and moderate ketonuria or ketonemia, as stated in the most recent and highest quality study 1. The diagnostic criteria for DKA include:
- Blood glucose level greater than 250 mg/dL
- Venous pH of 7.3 or less
- Serum bicarbonate level less than 18 mEq/L
- Moderate ketonuria or ketonemia These criteria are based on the study published in the American Family Physician in 2010 1, which provides the most recent and highest quality evidence for the diagnosis of DKA. Additional laboratory findings that support the diagnosis of DKA include an anion gap greater than 10-12 mEq/L and an elevated serum osmolality, as mentioned in the study published in Diabetes Care in 2004 1. It is essential to note that the nitroprusside method for measuring ketone levels should not be used as an indicator of response to therapy, as it only measures acetoacetic acid and acetone, and not beta-hydroxybutyrate, the strongest and most prevalent acid in DKA, as stated in the study published in Diabetes Care in 2003 1. The pathophysiology of DKA involves insulin deficiency leading to increased lipolysis and production of ketone bodies, which cause metabolic acidosis, and concurrent assessment of precipitating factors is crucial, as DKA is commonly triggered by infection, medication non-compliance, new-onset diabetes, or other acute stressors like myocardial infarction or stroke, as mentioned in the study published in the American Family Physician in 2010 1.
From the Research
Diagnostic Criteria for Diabetic Ketoacidosis (DKA)
The diagnostic criteria for DKA include:
- Serum glucose level greater than 250 mg per dL 2, 3, 4
- pH less than 7.3 2, 3, 4
- Serum bicarbonate level less than 18 mEq per L 2, 3
- Elevated serum ketone level 2, 5, 3
- Dehydration 2
- High anion gap metabolic acidosis 5, 6
- Ketonuria >++ 4
- Venous pH <7.3 and/or bicarbonate <15 mEq/l 4
Laboratory Findings
Laboratory findings that can help diagnose DKA include:
- Measurement of A1C, blood urea nitrogen, creatinine, serum glucose, electrolytes, pH, and serum ketones 2
- Complete blood count 2
- Urinalysis 2
- Electrocardiography 2
- Calculation of anion gap and osmolar gap 2
- Beta-hydroxybutyrate level 3, 6
Clinical Presentation
Common symptoms of DKA include: