From the Guidelines
To check for diabetic ketoacidosis (DKA), you should measure blood glucose, urine or blood ketones, and venous blood gases, with a focus on specific measurement of beta-hydroxybutyrate in blood for diagnosis and monitoring of DKA. DKA is diagnosed when blood glucose is typically >250 mg/dL, ketones are present in urine or blood, and there is metabolic acidosis with a pH <7.3 and bicarbonate <15 mEq/L, as indicated in the study 1. Begin by checking capillary blood glucose using a glucometer, then test for ketones using a blood ketone meter (which measures beta-hydroxybutyrate) as recommended by the most recent guidelines 1. If these are positive, obtain venous blood gases to assess pH and bicarbonate levels. Additional laboratory tests should include electrolytes to check for anion gap, complete blood count, renal function tests, and serum osmolality. Clinical signs to monitor include dehydration, Kussmaul breathing (deep, rapid breathing), fruity breath odor, abdominal pain, nausea/vomiting, and altered mental status.
Key Diagnostic Criteria
- Blood glucose >250 mg/dL
- Presence of ketones in urine or blood
- Metabolic acidosis with a pH <7.3 and bicarbonate <15 mEq/L
- Measurement of beta-hydroxybutyrate in blood for diagnosis and monitoring of DKA, as it is the strongest and most prevalent acid in DKA 1
Laboratory Tests
- Electrolytes to check for anion gap
- Complete blood count
- Renal function tests
- Serum osmolality
- Venous blood gases to assess pH and bicarbonate levels
Clinical Signs to Monitor
- Dehydration
- Kussmaul breathing (deep, rapid breathing)
- Fruity breath odor
- Abdominal pain
- Nausea/vomiting
- Altered mental status
The use of blood ketone determinations that rely on the nitroprusside reaction should not be used to monitor treatment of DKA, as they do not measure beta-hydroxybutyrate and may lead to incorrect assessments of ketosis resolution 1. The management goals include restoration of circulatory volume and tissue perfusion, resolution of hyperglycemia, and correction of electrolyte imbalance and acidosis, with individualization of treatment based on a careful clinical and laboratory assessment 1.
From the FDA Drug Label
Hyperglycemia (too much glucose in the blood) may develop if your body has too little insulin Hyperglycemia can be brought about by any of the following: Omitting your insulin or taking less than your doctor has prescribed. In patients with type 1 or insulin-dependent diabetes, prolonged hyperglycemia can result in DKA (a life-threatening emergency) The first symptoms of DKA usually come on gradually, over a period of hours or days, and include a drowsy feeling, flushed face, thirst, loss of appetite, and fruity odor on the breath. With DKA, blood and urine tests show large amounts of glucose and ketones.
To check for Diabetic Ketoacidosis (DKA), look for the following symptoms:
- Drowsy feeling
- Flushed face
- Thirst
- Loss of appetite
- Fruity odor on the breath
- Heavy breathing and rapid pulse (more severe symptoms) And check blood and urine tests for large amounts of glucose and ketones 2.
From the Research
Diagnosis of Diabetic Ketoacidosis (DKA)
To check for DKA, the following criteria can be used:
- Hyperglycemia (blood glucose greater than 250 mg/dL) 3, 4, 5
- Metabolic acidosis (pH less than 7.3, serum bicarbonate less than 18 mEq/L, anion gap greater than 10 mEq/L) 3, 4, 6
- Elevated serum or urine ketones 3, 4, 6, 5
Laboratory Tests
The following laboratory tests can be used to diagnose DKA and identify underlying causes and complications:
- Measurement of A1C, blood urea nitrogen, creatinine, serum glucose, electrolytes, pH, and serum ketones 3
- Complete blood count with differential 3, 4
- Urinalysis 3, 4
- Electrocardiography 3, 4
- Calculation of anion gap and osmolar gap 3
- Amylase, lipase, hepatic transaminase levels, troponin, creatine kinase, blood and urine cultures, and chest radiography may also be considered 4
Clinical Presentation
Common symptoms of DKA include: