Acceptable Lab Levels After DKA Resolution
DKA is considered resolved when glucose is <200 mg/dL, serum bicarbonate is ≥18 mEq/L, and venous pH is >7.3. 1, 2
Resolution Criteria
The American Diabetes Association defines complete DKA resolution by three specific laboratory parameters that must all be met simultaneously:
- Glucose <200 mg/dL - indicates resolution of hyperglycemia 1, 2
- Serum bicarbonate ≥18 mEq/L - indicates correction of metabolic acidosis 1, 2
- Venous pH >7.3 - confirms adequate acid-base balance 1, 2
- Anion gap ≤12 mEq/L - also indicates resolution of acidosis 1
Additional Monitoring Parameters
Beyond the core resolution criteria, several other laboratory values should normalize or stabilize:
- Beta-hydroxybutyrate (β-OHB) should normalize to <0.5 mmol/L, though this typically takes longer to clear than hyperglycemia 1
- Serum potassium should be maintained at 4-5 mEq/L during and after treatment 1
- Renal function (BUN/creatinine) should improve from admission values, as acute kidney injury commonly occurs during DKA 3
- Corrected serum sodium should normalize using the formula: measured Na + [(glucose - 100)/100] × 1.6 1
Critical Monitoring Pitfalls
- Do not rely on urine ketones to determine resolution - the nitroprusside method only measures acetoacetate and acetone, not β-OHB (the predominant ketone in DKA), and can paradoxically worsen during treatment as β-OHB converts to acetoacetate 1, 2
- Do not discontinue insulin prematurely before all three resolution criteria are met, as this leads to recurrence of ketoacidosis 1
- Monitor for hypoglycemia once glucose approaches 200 mg/dL - add dextrose to IV fluids while continuing insulin infusion to clear ketones 1
Transition Timing
Once resolution criteria are met: