Diabetic Ketoacidosis Diagnosis and Management

Patient Assessment and Diagnosis

The American Diabetes Association recommends considering diabetic ketoacidosis as the primary diagnosis for a patient presenting with an anion gap of 22 mmol/L, and evaluating for new-onset type 1 diabetes or discontinuation/inadequate insulin in established diabetes as the most common precipitating factors for DKA 1
Infection is a common precipitating factor for DKA, and patients may be normothermic or even hypothermic due to peripheral vasodilation, according to the American Diabetes Association 1
The American Diabetes Association suggests distinguishing DKA from other causes of ketoacidosis, such as starvation ketosis or alcoholic ketoacidosis, by evaluating glucose levels, with DKA typically requiring glucose ≥250 mg/dL 1

The American Diabetes Association recommends prioritizing the physical exam to assess volume status and mental status, with a focus on evaluating hydration status and assessing mental status carefully, as DKA can cause profound dehydration and altered consciousness 1, 3
Aggressive fluid resuscitation at 15-20 mL/kg/hour initially is recommended by the American Diabetes Association for patients with DKA, to address profound dehydration 1