Diabetic ketoacidosis laboratory findings
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
Laboratory Findings
Serum glucose
- The diagnosis of diabetic ketoacidosis is based on a serum glucose level of > 250mg/dl
Arterial blood gas (ABG)
- Arterial blood gas widely recommended test for determining pH
Diagnostic Criteria for Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State
| CRITERION | DIABETIC KETOACIDOSIS | ||
|---|---|---|---|
| MILD (SERUM GLUCOSE > 250 MG PER DL [13.88 MMOL PER L]) | MODERATE (SERUM GLUCOSE > 250 MG PER DL) | SEVERE (SERUM GLUCOSE > 250 MG PER DL) | |
| Anion gap* | > 10 mEq per L (10 mmol per L) | > 12 mEq per L (12 mmol per L) | > 12 mEq per L (12 mmol per L) |
| Arterial pH | 7.24 to 7.30 | 7.00 to < 7.24 | < 7.00 |
| Effective serum osmolality* | Variable | Variable | Variable |
| Mental status | Alert | Alert/drowsy | Stupor/coma |
| Serum bicarbonate | 15 to 18 mEq per L (15 to 18 mmol per L) | 10 to < 15 mEq per L (10 to < 15 mmol per L) | < 10 mEq per L (10 mmol per L) |
| Serum ketone† | Positive | Positive | Positive |
| Urine ketone† | Positive | Positive | Positive |
Calculations for the Evaluation of Diabetic Ketoacidosis
| VALUE | PURPOSE | FORMULA | NORMAL VALUE |
|---|---|---|---|
| Anion gap | Essential for evaluation of acid base disorders | Na– (Cl + HCO3) | 7 to 13 mEq per L (7 to 13 mmol per L) |
| Osmolar gap | Difference between measured osmolality and calculated osmolality | Osmolality (measured) – osmolality (calculated) | < 10 mmol per L* |
| Serum osmolality | Measure of particles in a fluid compartment | 2(Na + K) + (glucose/18) + (blood urea nitrogen/2.8) | 285 to 295 mOsm per kg (285 to 295 mmol per kg) of water |
| Serum sodium correction | Hyperglycemia causes pseudohyponatremia | Na + 0.016(glucose – 100) | 135 to 140 mEq per L (135 to 140 mmol per L) |
Suggested Laboratory Evaluation for Persons with Diabetic Ketoacidosis
| TEST | COMMENTS |
|---|---|
| For all patients | |
| A1C | 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) |