Diagnosis of Diabetic Ketoacidosis

By  , Expert Content
Jan 03, 2012

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If you have symptoms suggestive of diabetic ketoacidosis (DKA), your doctor will take a medical history, do physical exam and various blood tests to confirm the same.

Medical history and physical examination: Your doctor may ask question such as:

  • Do you have diabetes?
  • What medication do you take?
  • Have you missed your insulin dose/s?
  • How long have you had the symptoms (such as vomiting, pain abdomen and increased urination)?
  • Have you been treated for DKA before?


Tests that are done to diagnose diabetic ketoacidosis include:


Blood sugar level: Insulin deficiency does not allow sugar to enter the cells and therefore, the blood sugar level will rise (hyperglycemia) and the body may start using fat and protein for energy. Blood sugar levels in diabetic ketoacidosis are higher than 250 mg per dL (13.9 mmol per L) and if it is not treated, the sugar level will continue to rise.

Ketone level: Use of fat leads to the formation of a fat breakdown product called ketones. Ketones can be detected by urine or blood tests. Urine and blood tests for ketones are positive in people with diabetic ketoacidosis.

Blood acidity: Increase in ketone levels in blood will make your blood acidic (acidosis). In people with moderate DKA, the pH is 7.00 to 7.24 and in severe DKA, the pH is less than 7.00.Decrease in pH (acidosis) can damage organs throughout your body. Arterial blood is tested to determine blood pH.

Blood bicarbonate level: Bicarbonate in blood is usually low in DKA. In mild DKA, it is 15 to 18mEq per L, in moderate DKA, the level is about 10 to 15mEq per L and in severe DKA, it is less than 10 mEq per L. It may be normal or high in patients with vomiting, diuretic use or alkali ingestion.

Other tests: Other tests that may be done to identify any underlying health problems that may have contributed to diabetic ketoacidosis and check for complications include:

  • Blood urea nitrogen and Creatinine.
  • Blood electrolyte tests.
  • Complete blood count with differential (to determine if there is an infection).
  • Bacterial cultures of urine, blood, throat or other sites if infection is suspected.
  • Chest radiography if pneumonia or heart disease is suspected.
  • HbA1C level to determine long term blood sugar control.
  • Urinalysis to test for ketones, infection.
  • Chest X-ray.
  • A recording of the electrical activity of the heart (electrocardiogram).


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