From the Guidelines
Diabetic ketoacidosis (DKA) is diagnosed when a patient has the triad of hyperglycemia, ketosis, and metabolic acidosis, with diagnostic criteria including: blood glucose >250 mg/dl, arterial pH <7.3, bicarbonate <15 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 greater than 250 mg/dL
- Arterial pH less than 7.3
- Serum bicarbonate less than 15 mEq/L
- Moderate ketonuria or ketonemia These criteria are used to diagnose DKA, which is a serious complication of diabetes that can lead to morbidity and mortality if not treated promptly and effectively. The severity of DKA can be classified as:
- Mild: arterial pH 7.25-7.30, bicarbonate 15-18 mEq/L
- Moderate: pH 7.00-7.24, bicarbonate 10-14 mEq/L
- Severe: pH <7.00, bicarbonate <10 mEq/L Additional laboratory findings often include an elevated anion gap, ketonemia, and ketonuria. Patients usually present with symptoms such as:
- Polyuria
- Polydipsia
- Nausea
- Vomiting
- Abdominal pain
- Altered mental status The underlying pathophysiology involves insulin deficiency combined with increased counter-regulatory hormones, leading to increased glucose production, decreased glucose utilization, and increased lipolysis with subsequent ketogenesis, as noted in 1. It's essential to note that euglycemic DKA can occur, particularly in patients taking SGLT2 inhibitors, where blood glucose may be less than 250 mg/dL despite meeting other DKA criteria, as mentioned in 1.
From the Research
DKA Criteria
The criteria for diagnosing Diabetic Ketoacidosis (DKA) include:
- 'D', either elevated blood glucose levels or a family history of diabetes mellitus 2
- 'K', the presence of high urinary or blood ketoacids 2
- 'A', a high anion gap metabolic acidosis 2 DKA is characterized by hyperglycemia, metabolic acidosis, and ketosis 3, 4, 5
Key Characteristics
The key characteristics of DKA are:
Diagnostic Considerations
DKA can be diagnosed based on the presence of the three criteria ('D', 'K', and 'A') 2 The diagnosis of DKA is often made in the context of hyperglycemia, ketosis, and acidosis 6, 3, 4, 5