The presence of diabetic ketoacidosis can be made if certain conditions are met.
The classic triad of diabetic ketoacidosis is:
(1) history of diabetes, typically with hyperglycemia (blood glucose > 11 mmol/L, often > 13.75 mmol/L)
(2) ketonemia (beta-hydroxybutyrate > 3 mmol/L) and ketonuria (> 2+)
(3) high anion gap metabolic acidosis with arterial pH < 7.3
The serum bicarbonate is typically reduced (< 15 mmol/L).
Exceptions to the classic triad are not uncommon:
(1) euglycemic diabetic ketoacidosis: history of diabetes with blood glucose mildly elevated
(2) normal arterial pH and bicarbonate if there is metabolic alkalosis from vomiting
(3) negative urine test for ketones
Differential diagnosis:
(1) non-diabetic ketoacidosis
(2) hyperglycemic hyperosmolar state
(3) infection or intoxication
If the BHBA is normal or slightly elevated but the serum lactate or anion gap are moderately to markedly elevated, then consider another diagnosis.
