Laboratory Tests for Diagnosing Euglycemic Diabetic Ketoacidosis

Essential Laboratory Tests

The initial laboratory evaluation for diagnosing euglycemic diabetic ketoacidosis must include plasma glucose, blood urea nitrogen/creatinine, serum ketones, electrolytes with calculated anion gap, arterial blood gases, and urinalysis with urine ketones by dipstick, as recommended by the American Diabetes Association 1, 2, 3
Arterial blood gases are essential to document metabolic acidosis, with an arterial pH <7.3, according to the American Diabetes Association 1, 3
Serum bicarbonate should be measured to confirm levels ≤15-18 mEq/L, as suggested by the American Diabetes Association 1, 4
Serum ketones, specifically β-hydroxybutyrate, should be measured, as recommended by the American Diabetes Association 4
Electrolytes with calculated anion gap are critical to document high anion gap metabolic acidosis, according to the American Diabetes Association 1
Blood urea nitrogen/creatinine is important to assess renal function and hydration status, as recommended by the American Diabetes Association 1
Urinalysis with urine ketones provides supporting evidence but should not be used alone for diagnosis, according to the American Diabetes Association 4
Complete blood count with differential is necessary to evaluate for underlying infection, as suggested by the American Diabetes Association 1, 3

β-hydroxybutyrate measurement is the predominant ketone in DKA and should be specifically measured, as recommended by the American Diabetes Association 4
Serum osmolality should be calculated to help differentiate from other causes of acidosis, according to the American Diabetes Association 1, 5

Nitroprusside-based blood ketone tests should not be used for monitoring treatment, as they do not measure βOHB, according to the American Diabetes Association 4
Urine ketone testing alone is insufficient for diagnosis and may be misleading, as recommended by the American Diabetes Association 4

Measure arterial blood gases to confirm metabolic acidosis, with an arterial pH <7.3, as recommended by the American Diabetes Association 1, 3
Measure serum bicarbonate, which should be ≤15-18 mEq/L, according to the American Diabetes Association 1
Calculate anion gap, which should be elevated, as recommended by the American Diabetes Association 1
Measure serum β-hydroxybutyrate or serum ketones, as suggested by the American Diabetes Association 4
Exclude other causes of high anion gap metabolic acidosis, such as lactic acidosis, salicylate toxicity, and methanol/ethylene glycol ingestion, according to the American Diabetes Association 1, 3
Obtain complete blood count, electrolytes, BUN/creatinine to assess overall status and identify precipitating factors, as recommended by the American Diabetes Association 1