Diagnostic Criteria and Monitoring for Diabetic Ketoacidosis (DKA)

Essential Laboratory Tests for DKA Diagnosis

The American Diabetes Association recommends measurement of blood glucose, blood β-hydroxybutyrate (bOHB), venous pH, serum bicarbonate, and calculation of anion gap for the diagnosis of DKA 1, 2
Blood β-hydroxybutyrate (bOHB) measurement is the preferred method for diagnosis of DKA, with a specific measurement in blood being the most accurate method 2, 3
Venous pH value <7.3 is diagnostic for DKA, according to the American Association of Clinical Endocrinologists 4
Serum bicarbonate value <18 mEq/L is diagnostic for DKA, as recommended by the American Diabetes Association 3, 4
Serum electrolytes are needed to calculate anion gap and assess electrolyte imbalances, as suggested by the American College of Endocrinology 4, 5

Blood bOHB testing is more accurate than urine ketone testing, as bOHB is the predominant ketone body in DKA, according to the American Diabetes Association 1, 6
Blood bOHB measurement can detect ketosis earlier than traditional nitroprusside methods, as recommended by the American Association of Clinical Endocrinologists 6, 3

Urine ketones have limitations, including high negative predictive value but limited ability to quantify the degree of ketosis, as noted by the American College of Endocrinology 1, 7
Nitroprusside method only measures acetoacetate and acetone, not bOHB, which can lead to inaccurate diagnosis, according to the American Diabetes Association 4, 2

Blood glucose, electrolytes, BUN, creatinine, venous pH, and anion gap should be monitored every 2-4 hours during treatment, as recommended by the American Association of Clinical Endocrinologists 4, 5
Blood bOHB is the preferred method for monitoring ketosis resolution during treatment, according to the American College of Endocrinology 4, 5

Glucose <200 mg/dL is one of the criteria for DKA resolution, as suggested by the American Diabetes Association 5
Serum bicarbonate ≥18 mEq/L is one of the criteria for DKA resolution, according to the American Association of Clinical Endocrinologists 5
Venous pH >7.3 is one of the criteria for DKA resolution, as recommended by the American College of Endocrinology 5
Anion gap ≤12 mEq/L is one of the criteria for DKA resolution, as noted by the American Diabetes Association 5

Blood bOHB testing is superior to urine ketone testing for both diagnosis and monitoring of DKA, according to the American Diabetes Association 2, 3
Nitroprusside-based blood ketone tests should not be used to monitor treatment of DKA, as recommended by the American Association of Clinical Endocrinologists 2, 8