Diagnostic Criteria and Monitoring for Euglycemic Diabetic Ketoacidosis (DKA)
Essential Diagnostic Criteria
- The American Diabetes Association recommends that euglycemic DKA be diagnosed based on elevated blood β-hydroxybutyrate (bOHB) levels, with a preferred cutoff value of ≥6.3 mmol/L, in combination with evidence of metabolic acidosis, indicated by venous pH <7.3 and serum bicarbonate <18 mEq/L 1, 2
- The diagnostic criteria for euglycemic DKA include blood glucose <200 mg/dL, elevated bOHB, venous pH <7.3, serum bicarbonate <18 mEq/L, and elevated anion gap (>12 mEq/L) 3, 2
Recommended Laboratory Tests
- The American Association of Clinical Endocrinologists recommends a comprehensive laboratory evaluation, including blood glucose, serum β-hydroxybutyrate (bOHB), venous blood gases, serum electrolytes, serum bicarbonate, and calculation of anion gap, to diagnose and monitor euglycemic DKA 3, 4, 5
- Blood urea nitrogen (BUN) and creatinine should be measured to assess renal function in patients with euglycemic DKA 4, 5
Monitoring During Treatment
- The Endocrine Society recommends monitoring blood glucose, electrolytes, BUN, creatinine, venous pH, and anion gap every 2-4 hours during treatment of euglycemic DKA 4, 2
- Blood bOHB is the preferred method for monitoring ketosis resolution, with decreasing levels indicating improvement 1, 2