Differentiating Diabetic ketoacidosis from other diseases

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Differentiating Diabetic Ketoacidosis From Other Diseases

Diabetic ketoacidosis must be differentiated from other diseases causing the following conditions:

• Other conditions causing hyperglycemia
  • Diabetes mellitus
  • Non-ketotic hyperosmolar state
  • Impaired glucose tolerance
  • Stress hyperglycemia
• Other conditions causing ketosis
  • Ketotic hypoglycemia
  • Alcoholic ketosis
  • Starvation ketosis
• Other conditions causing metabolic acidosis
  • Lactic acidosis
  • Salicylic acid ingestion
  • Uremic acidosis
  • Drug-induced acidosis

Characteristic Common to DKA	Condition	History Findings	Clinical Features	Lab abnormalities
Hyperglycemia	Diabetes mellitus	Family history of diabetes Obesity (BMI >25 kg/m2) Stress Sedentary lifestyle History of gestational diabetes Polycystic ovarian syndrome Acanthosis nigricans Hypertension (>140/90 mmHg)	Polyuria Polydipsia Polyphagia Weight loss Central obesity Autonomic and peripheral neuropathy Vascular occlusion secondary to atherosclerosis (Stroke, myocardial infarction) Renal impairment (microalbuminuria leading to renal failure) Decreased visual acuity (diabetic retionopathy) Increased susceptibility to infections Charcot's joints	Hyperglycemia: Fasting blood glucose level: >126 mg/dl Random blood glucose level: >200 mg/dl HbA1C: >6.5 % Urinanalysis may show: Proteinuria Glucosuria Positive antibodies:(Type 1 diabetes) Anti-glutamic acid decarboxylase Anti-islet cell Anti-insulin
	Non-ketotic hyperosmolar state	Elderly with type 2 diabetes mellitus Undiagnosed type 2 diabetes Prolonged hyperglycemia	May have all clinical features of diabetes mellitus plus: Hypotenion Dehydration Tachycardia Decreased mentation Focal neurological abnormalities	Hyperglycemia (600-2000 mg/dl) Increased serum osmolarity (330-380 mOsm/kg) Arterial pH >7.3 Anion gap normal No ketosis
	Impaired glucose tolerance	Family history of diabetes Obesity (BMI >25 kg/m2) Stress Sedentary lifestyle History of gestational diabetes Acanthosis nigricans	May have all clinical features of diabetes mellitus	Hyperglycemia: Fasting blood glucose level: 100-125 mg/dl Oral glucose tolerance test 140-200 mg/dl
	Stress hyperglycemia
Ketosis	Alcoholic ketosis	Non-diabetic chronic alcohol user Binge drinking history Fasting for 1-2 days after binge drinking	Nasuea Vomiting Diffuse abdominal pain Dehydration Stress Anorexia	Serum glucose normal (only 10% with serum glucose >250 mg/dl) Arterial pH may show acidosis or may be alkalotic due to respiratory alkalosis Increased anion gap Acetoacetate and beta hydroxybutyrate elevated
	Starvation ketosis
Metabolic acidosis	Lactic acidosis
	Salicylic acid ingestion
	Uremic acidosis
	Drug-induced acidosis