What questions should be asked to rule out Diabetic Ketoacidosis (DKA)?

From the Guidelines

To rule out diabetic ketoacidosis (DKA), you should ask about symptoms including excessive thirst, frequent urination, nausea, vomiting, abdominal pain, weakness, fatigue, confusion, fruity-scented breath, and rapid breathing, as these are key indicators of the condition, according to the most recent guidelines 1. When evaluating a patient for DKA, it is essential to consider the following key points:

• Inquire about blood glucose levels, specifically if they are elevated above 250 mg/dL, as this is a critical criterion for diagnosing DKA 1.
• Ask about ketone testing results in urine or blood, as moderate to high levels suggest DKA 1.
• Question the patient about their insulin regimen adherence, missed doses, or insulin pump malfunctions, as these can precipitate DKA 1.
• Determine if there are any precipitating factors such as infection, illness, surgery, trauma, or emotional stress, which can trigger DKA 1.
• Ask about fluid intake and signs of dehydration, as these are critical components of DKA management 1.
• For patients with diabetes, inquire about their history of DKA episodes and how their current symptoms compare, to assess the risk of recurrent DKA. These questions help identify DKA, which is characterized by the triad of hyperglycemia, ketosis, and metabolic acidosis resulting from insulin deficiency. Prompt identification is crucial as DKA is a medical emergency requiring immediate treatment with insulin, fluids, and electrolyte management.

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. Eating significantly more than your meal plan suggests. Developing a fever, infection, or other significant stressful situation. 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. Heavy breathing and a rapid pulse are more severe symptoms If uncorrected, prolonged hyperglycemia or DKA can lead to nausea, vomiting, stomach pain, dehydration, loss of consciousness, or death.

To rule out Diabetic Ketoacidosis (DKA), consider asking the following questions:

• Has the patient omitted their insulin or taken less than prescribed?
• Has the patient eaten significantly more than their meal plan suggests?
• Is the patient experiencing a fever, infection, or other significant stressful situation?
• Does the patient have a history of type 1 or insulin-dependent diabetes?
• Is the patient experiencing any of the following symptoms:
  • Drowsy feeling
  • Flushed face
  • Thirst
  • Loss of appetite
  • Fruity odor on the breath
  • Heavy breathing
  • Rapid pulse
  • Nausea
  • Vomiting
  • Stomach pain
  • Dehydration
  • Loss of consciousness 2, 2, 2

From the Research

Questions to Rule Out DKA

To rule out Diabetic Ketoacidosis (DKA), the following questions can be asked:

• What are the patient's symptoms, such as polyuria, polydipsia, nausea, vomiting, abdominal pain, weight loss, severe fatigue, dyspnea, and preceding febrile illness? 3
• Has the patient experienced any recent stressors or illnesses that could trigger DKA? 3
• Is the patient taking any medications, such as sodium-glucose cotransporter-2 inhibitors, that could increase the risk of DKA? 3
• Does the patient have a history of alcohol or cocaine abuse, which could be associated with abdominal pain in DKA? 4
• Are there any signs of severe metabolic acidosis, such as low serum bicarbonate levels or low blood pH? 4
• Has the patient been diagnosed with diabetes, and if so, what is their current treatment plan? 3
• Are there any other potential causes of the patient's symptoms, such as acute abdomen or other medical conditions? 4

Laboratory Tests

The following laboratory tests can be ordered to help rule out DKA:

• Blood glucose levels to check for hyperglycemia 3
• Electrolyte panels to check for metabolic acidosis 3
• Serum ketone levels to check for ketosis 3
• Complete blood cell count with differential to check for signs of infection or other conditions 3
• Urinalysis to check for ketones or other abnormalities 3
• Amylase and lipase levels to check for pancreatitis 3
• Hepatic transaminase levels to check for liver damage 3
• Troponin and creatine kinase levels to check for cardiac damage 3
• Blood and urine cultures to check for infection 3
• Chest radiography to check for pulmonary complications 3