Diabetic Ketoacidosis Diagnosis and Management

Key Diagnostic Features

The American Diabetes Association recommends that acetone breath (fruity/nail polish odor) is specific for ketosis and indicates DKA, not simple hyperglycemia or isolated hyponatremia 1, 2
Vomiting accompanied by hyperglycemia and signs of ketosis indicates DKA, which is a life-threatening condition requiring immediate medical care 3, 4
The presence of altered mental status, such as lethargy, is consistent with DKA, where mental status changes range from lethargy to coma 1

The American Diabetes Association guidelines state that DKA diagnosis requires plasma glucose >250 mg/dL, arterial pH <7.3, serum bicarbonate <18 mEq/L, positive serum or urine ketones, and anion gap >10 mEq/L 1, 2
Approximately 10% of DKA cases present as euglycemic DKA (glucose <200 mg/dL), which can occur with reduced food intake, vomiting, pregnancy, or alcohol use 2

The American Diabetes Association recommends urgent evaluation and treatment, including obtaining arterial blood gas, serum ketones, complete metabolic panel, and anion gap immediately 1, 7
Isotonic saline (0.9% NaCl) should be administered at 15-20 mL/kg/hour for volume resuscitation, and continuous intravenous insulin infusion should be started once DKA is confirmed 6, 7
Blood glucose should be monitored every 1-2 hours and electrolytes frequently, and insulin should never be discontinued even if the patient cannot eat 6, 5