Diabetic ketoacidosis


Diagnosis of diabetes-related ketoacidosis (DKA) typically involves assessing four key conditions:

  • Blood glucose level exceeding 250 mg/dL. (Note: Euglycemic diabetes-related ketoacidosis [euDKA], with blood sugar below 250, is less common.)
  • Blood pH below 7.3, indicating acidosis.
  • Presence of ketones in urine and/or blood.
  • Serum bicarbonate level below 18 mEq per L.

In a hospital setting, healthcare professionals may employ various tests for DKA diagnosis, including:

  • Blood glucose testing.
  • Ketone testing via urine or blood analysis.
  • Arterial blood gas analysis.
  • Basic metabolic panel evaluation.
  • Blood pressure measurement.
  • Osmolality blood testing.


If diagnosed with diabetic ketoacidosis, emergency room treatment or hospital admission is common. The typical approach involves:

  • Fluid administration: Fluids are administered to replenish those lost due to excessive urination. This aids in diluting elevated blood sugar levels. Fluids can be administered orally or intravenously (IV).
  • Insulin therapy: Insulin is a key component in reversing diabetic ketoacidosis. Alongside fluids and electrolytes, insulin is typically administered through a vein. Transitioning back to regular insulin therapy becomes feasible when blood sugar levels drop to around 200 mg/dL (11.1 mmol/L), and the blood’s acidity is normalized.
  • Electrolyte replacement: Electrolytes, such as sodium, potassium, and chloride, play a crucial role in maintaining the body’s electric balance. In cases of insufficient insulin, electrolyte levels can drop. IV electrolyte replacement is employed to ensure proper functioning of the heart, muscles, and nerve cells.