Public - Diabetic Ketoacidosis

Diabetic Ketoacidosis

Author: Heather Lochnan, MD
Approved for review - 2009-03-25
Author information and module status



		Prevention
		Screening
		Diagnosis
		Consultation for Diagnosis
		Hospitalization
		Non-drug Therapy
		Drug Therapy
		Patient Education
		Consultation for Management
		Follow-up

	Tables
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	References
	Glossary
	What's New
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Diagnosis
Take a careful history for symptoms suggesting hyperglycemia or DKA. Perform a physical exam looking for signs of elevated blood sugar and DKA. Consider DKA in diabetic patients with neurologic impairment. Consider DKA in patients with type 2 diabetes who are dehydrated, acidotic, or who have very high blood sugars. Consider DKA if hyperglycemia, acidosis, or ketonemia are present. Consider a diagnosis other than DKA if there is no response to therapy. Consider another diagnosis if blood glucose is <250 mg/dL.
History and Physical Examination Elements for Diabetic Ketoacidosis (table)
Laboratory and Other Studies for Diabetic Ketoacidosis (table)
Differential Diagnosis of Diabetic Ketoacidosis (table)


Take a careful history for symptoms suggesting hyperglycemia or DKA.
Screen patients for symptoms of hyperglycemia. Consider DKA in patients with polyuria, polydipsia, nausea, and vomiting. See table History and Physical Examination Elements for Diabetic Ketoacidosis.
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Perform a physical exam looking for signs of elevated blood sugar and DKA.
Examine for dehydration. Check for fruity smelling breath if DKA is suspected. Suspect DKA in patients with Kussmaul breathing. Screen patients with Kussmaul breathing (rapid, deep breaths) for DKA. See table History and Physical Examination Elements for Diabetic Ketoacidosis.
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Consider DKA in diabetic patients with neurologic impairment.
Ensure that insulin or oral antidiabetic therapy is not interrupted in hospitalized patients with diabetes because DKA could develop. Measure the anion gap, blood gases, and blood sugar levels if neurologic status is impaired in patients with diabetes. See table History and Physical Examination Elements for Diabetic Ketoacidosis.
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Consider DKA in patients with type 2 diabetes who are dehydrated, acidotic, or who have very high blood sugars.
Measure the anion gap, blood gases, and serum ketone levels when patients with type 2 diabetes are dehydrated or hyperglycemic. See table History and Physical Examination Elements for Diabetic Ketoacidosis.
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Consider DKA if hyperglycemia, acidosis, or ketonemia are present.
Diagnose DKA when the blood glucose is ≥250 mg/dL, arterial pH ≤7.30, serum bicarbonate ≤15 mEq/L, and positive serum ketones. Measure: Plasma glucose and capillary blood glucose levels urgently Arterial blood gas level to assess acid-base status Serum and urine ketone levels Serum potassium level The anion gap (Na⁺ − [Cl^- + HCO₃ ^-]) See table Laboratory and Other Studies for Diabetic Ketoacidosis.
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Consider a diagnosis other than DKA if there is no response to therapy.
Exclude other causes of high anion gap metabolic acidosis, ketonemia, and/or hyperglycemia. See table Differential Diagnosis of Diabetic Ketoacidosis. See figure Differential Diagnosis of Diabetic Ketoacidosis.
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Consider another diagnosis if blood glucose is <250 mg/dL.
Consider alcoholic ketoacidosis or other causes of metabolic acidosis if blood glucose is not significantly elevated. See table Differential Diagnosis of Diabetic Ketoacidosis.
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FAQs

Ebenezer A. Nyenwe, MD, editorial consultant, has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Heather Lochnan, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
Deborah Korenstein, MD, FACP, Co-Editor, PIER, has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Richard B. Lynn, MD, FACP, Co-Editor, PIER, has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.

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