Diabetic ketoacidosis laboratory findings

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

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Laboratory Findings

LAB	FORMULA/ VARIABLE	PURPOSE	NORMAL VALUE	VALUE IN DKA
Arterial blood gas	Blood pH	Evaluation of acid-base status of the body	7.35-7.45	<7.3
	Serum bicarbonate		22-26 mEq/L	<18 mEq/L
	Arterial CO2		35-45 mmHg	Decreased secondary to hyperventilation as a compensation to metabolic acidosis
	Arterial O2		75-100 mmHg	Within normal range unless there is concomitant respiratory infection e.g. pneumonia leading to hypoxia)
Anion gap	Na– (Cl + HCO3)	Evaluation of acid base disorders	7 to 13 mEq/L (7 to 13 mmol/L)	Increased
Osmolar gap	Osmolality (measured) – osmolality (calculated)	Difference between measured osmolality and calculated osmolality	< 10 mmol/L	Increased
Serum osmolality	2(Na + K) + (glucose/18) + (blood urea nitrogen/2.8)	Measure of particles in a fluid compartment	285 to 295 mOsm/kg (285 to 295 mmol/kg) of water	Increased
Serum sodium correction	Na + 0.016(glucose – 100)	Hyperglycemia causes pseudohyponatremia	135 to 140 mEq per L (135 to 140 mmol per L)	N/A

Suggested Laboratory Evaluation for Persons with Diabetic Ketoacidosis

TEST	COMMENTS
HbA1C	To determine level of glycemic control in persons with diabetes mellitus
Anion gap (electrolytes)	Usually greater than 15 mEq per L (15 mmol per L)
Arterial blood gas measurement	Below 7.3
	Arterial blood gas measurement is the most widely recommended test for determining pH, but measurement of venous blood gas has gained acceptance
Blood urea nitrogen, creatinine levels	Usually elevated because of dehydration and decreased renal perfusion
Complete blood count (with differential)	May be elevated in persons with DKA, but without pancreatitis
	Diagnosis of pancreatitis should be based on clinical judgment and imaging
Electrocardiography	Assesses effect of potassium status; rules out ischemia or myocardial infarction
Serum bicarbonate level	Less than 18 mEq per L (18 mmol per L)