From the Guidelines
DKA is considered resolved when blood glucose is <200 mg/dl, serum bicarbonate is ≥18 mEq/l, and venous pH is >7.3, as indicated by the most recent and highest quality study 1. The resolution of diabetic ketoacidosis (DKA) is determined by several key clinical and laboratory parameters.
- Blood glucose should be <200 mg/dl
- Serum bicarbonate should be ≥18 mEq/l
- Venous pH should be >7.3 Additionally, the patient should be able to eat and drink, and ketones should be cleared from the blood or significantly reduced.
- Mental status should return to baseline
- The patient should no longer have significant nausea, vomiting, or abdominal pain Typically, patients will also demonstrate improved hydration status with normal vital signs, including heart rate and blood pressure. It's essential to continue intravenous insulin until the anion gap closes and ketosis resolves, even if blood glucose normalizes earlier, as premature discontinuation of insulin can lead to recurrence of ketoacidosis, as supported by 1. Once DKA has resolved, patients can transition from intravenous insulin to subcutaneous insulin, with the first dose of subcutaneous insulin given 1-2 hours before stopping the insulin infusion to prevent rebound hyperglycemia, as recommended by 1. The underlying cause of DKA should also be identified and addressed to prevent recurrence. In contrast to an older study 1, the more recent study 1 provides the most up-to-date criteria for resolving DKA, which should be prioritized in clinical practice.
From the Research
Resolution of Diabetic Ketoacidosis (DKA)
The resolution of DKA is indicated by the following signals:
- Normalization of blood glucose levels 2, 3
- Clearance of ketones from the blood and urine 3
- Correction of acid-base disturbances, including the normalization of the anion gap and bicarbonate levels 4, 5
- Improvement in the patient's hydration status, as evidenced by the normalization of the urea/creatinine ratio 4
- Resolution of metabolic acidosis, as indicated by the normalization of the serum pH and bicarbonate levels 5, 6
Laboratory Criteria for Resolution of DKA
The resolution of DKA is confirmed when the following laboratory criteria are met:
- Blood glucose levels < 200 mg/dL 2, 3
- Serum anion gap < 12 mEq/L 5
- Serum bicarbonate levels > 18 mEq/L 5
- Urine ketones negative or trace 3
- Serum pH > 7.3 5, 6
Clinical Criteria for Resolution of DKA
The resolution of DKA is also indicated by the following clinical criteria: