Diabetic ketoacidosis laboratory findings

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Laboratory findings consistent with the diagnosis of diabetic ketoacidosis (DKA) include blood pH < 7.3, serum bicarbonate < 18 mEq/L, anion gap > 10 mEq/L and increased serum osmolarity.

Laboratory Findings

The following lab abnormalities may be found in diabetic ketoacidosis (DKA):^[1]^[2]^[3]^[4]^[5]^[6]^[7]

LAB	FORMULA/ VARIABLE	PURPOSE	NORMAL VALUE	VALUE IN DKA
Arterial blood gas	Blood pH	Evaluation of acid-base status of the body	7.35-7.45	<7.3
	Serum bicarbonate		22-26 mEq/L	<18 mEq/L
	Arterial CO2		35-45 mmHg	Decreased secondary to hyperventilation as a compensation to metabolic acidosis
	Arterial O2		75-100 mmHg	Within normal range unless there is concomitant respiratory infection e.g. pneumonia leading to hypoxia)
Anion gap	Na– (Cl + HCO3)	Evaluation of acid base disorders	7 to 13 mEq/L (7 to 13 mmol/L)	Increased (>10 mEq/L required for diagnosis)
Osmolar gap	Osmolality (measured) – osmolality (calculated)	Difference between measured osmolality and calculated osmolality	< 10 mmol/L	Increased
Serum osmolality	2(Na + K) + (glucose/18) + (blood urea nitrogen/2.8)	Measure of particles in a fluid compartment	285 to 295 mOsm/kg (285 to 295 mmol/kg) of water	Increased
Serum sodium correction	Na + 0.016(glucose – 100)	Hyperglycemia causes pseudohyponatremia	135 to 140 mEq per L (135 to 140 mmol per L)	N/A
Blood urea nitrogen, creatinine levels	N/A	To assess renal function	7-20 mg/dl 0.8-1.2mg/dl	Increased (Dehydration and decreased renal perfusion)
Complete blood count (with differential)	N/A	Assess infection To rule out pancreatitis		Increased

Deficits in diabetic ketoacidosis

The following deficits may be seen in mild DKA:^[8]

Total water (L): 6
Water (mL/kg): 100
Na+ (mEq/kg): 7 to 10
Cl- (mEq/kg): 3 to 5
K+ (mEq/kg): 3 to 5
PO4 (mmol/kg): 5 to 7
Mg++ (mEq/kg): 1 to 2
Ca++ (mEq/kg): 1 to 2

References

↑ Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN (2009). “Hyperglycemic crises in adult patients with diabetes”. Diabetes Care. 32 (7): 1335–43. doi:10.2337/dc09-9032. PMC 2699725. PMID 19564476.
↑ Chiasson JL, Aris-Jilwan N, Bélanger R, Bertrand S, Beauregard H, Ekoé JM, Fournier H, Havrankova J (2003). “Diagnosis and treatment of diabetic ketoacidosis and the hyperglycemic hyperosmolar state”. CMAJ. 168 (7): 859–66. PMC 151994. PMID 12668546.
↑ Liamis G, Liberopoulos E, Barkas F, Elisaf M (2014). “Diabetes mellitus and electrolyte disorders”. World J Clin Cases. 2 (10): 488–96. doi:10.12998/wjcc.v2.i10.488. PMC 4198400. PMID 25325058.
↑ Adrogué HJ, Lederer ED, Suki WN, Eknoyan G (1986). “Determinants of plasma potassium levels in diabetic ketoacidosis”. Medicine (Baltimore). 65 (3): 163–72. PMID 3084904.
↑ Xu W, Wu HF, Ma SG, Bai F, Hu W, Jin Y, Liu H (2013). “Correlation between peripheral white blood cell counts and hyperglycemic emergencies”. Int J Med Sci. 10 (6): 758–65. doi:10.7150/ijms.6155. PMC 3638300. PMID 23630441.
↑ Molitch ME, Rodman E, Hirsch CA, Dubinsky E (1980). “Spurious serum creatinine elevations in ketoacidosis”. Ann. Intern. Med. 93 (2): 280–1. PMID 6773457.
↑ Gokel Y, Paydas S, Koseoglu Z, Alparslan N, Seydaoglu G (2000). “Comparison of blood gas and acid-base measurements in arterial and venous blood samples in patients with uremic acidosis and diabetic ketoacidosis in the emergency room”. Am. J. Nephrol. 20 (4): 319–23. doi:13607 Check |doi= value (help). PMID 10970986.
↑ Kitabchi AE, Umpierrez GE, Murphy MB, Barrett EJ, Kreisberg RA, Malone JI, Wall BM (2001). “Management of hyperglycemic crises in patients with diabetes”. Diabetes Care. 24 (1): 131–53. PMID 11194218.

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[pmid19564476-1] Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN (2009). “Hyperglycemic crises in adult patients with diabetes”. Diabetes Care. 32 (7): 1335–43. doi:10.2337/dc09-9032. PMC 2699725. PMID 19564476.

[pmid12668546-2] Chiasson JL, Aris-Jilwan N, Bélanger R, Bertrand S, Beauregard H, Ekoé JM, Fournier H, Havrankova J (2003). “Diagnosis and treatment of diabetic ketoacidosis and the hyperglycemic hyperosmolar state”. CMAJ. 168 (7): 859–66. PMC 151994. PMID 12668546.

[pmid25325058-3] Liamis G, Liberopoulos E, Barkas F, Elisaf M (2014). “Diabetes mellitus and electrolyte disorders”. World J Clin Cases. 2 (10): 488–96. doi:10.12998/wjcc.v2.i10.488. PMC 4198400. PMID 25325058.

[pmid3084904-4] Adrogué HJ, Lederer ED, Suki WN, Eknoyan G (1986). “Determinants of plasma potassium levels in diabetic ketoacidosis”. Medicine (Baltimore). 65 (3): 163–72. PMID 3084904.

[pmid23630441-5] Xu W, Wu HF, Ma SG, Bai F, Hu W, Jin Y, Liu H (2013). “Correlation between peripheral white blood cell counts and hyperglycemic emergencies”. Int J Med Sci. 10 (6): 758–65. doi:10.7150/ijms.6155. PMC 3638300. PMID 23630441.

[pmid6773457-6] Molitch ME, Rodman E, Hirsch CA, Dubinsky E (1980). “Spurious serum creatinine elevations in ketoacidosis”. Ann. Intern. Med. 93 (2): 280–1. PMID 6773457.

[pmid10970986-7] Gokel Y, Paydas S, Koseoglu Z, Alparslan N, Seydaoglu G (2000). “Comparison of blood gas and acid-base measurements in arterial and venous blood samples in patients with uremic acidosis and diabetic ketoacidosis in the emergency room”. Am. J. Nephrol. 20 (4): 319–23. doi:13607 Check |doi= value (help). PMID 10970986.

[pmid11194218-8] Kitabchi AE, Umpierrez GE, Murphy MB, Barrett EJ, Kreisberg RA, Malone JI, Wall BM (2001). “Management of hyperglycemic crises in patients with diabetes”. Diabetes Care. 24 (1): 131–53. PMID 11194218.

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Diabetic ketoacidosis laboratory findings

Overview

Laboratory Findings

Deficits in diabetic ketoacidosis

References

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