Initial testing is important in the diagnosis and management of diabetic ketoacidosis (DKA).
Patient selection: diabetic ketoacidosis (DKA)
Generally ordered tests include:
(1) blood glucose
(2) beta-hydroxybutyrate concentration in serum
(3) urine ketones
(4) blood pH
(5) serum lactic acid
(6) serum potassium
(7) serum sodium
(8) serum magnesium
(9) serum calcium
(10) serum chloride
(11) serum phosphate
(12) serum bicarbonate
(13) serum creatinine and BUN
(14) urinalysis
(15) CBC with differential
(16) ECG
(17) serum osmolarity
The presence of ketones is not specific for diabetic ketoacidosis. Urine ketone testing using nitroprusside reagent primarily detects acetoacetate and may be negative in rare cases of DKA. In addition, urine testing may be delayed if the patient has oliguria.
A mild increase in the white blood cell count can be seen in diabetic ketoacidosis in the absence of infection.
Derived values are:
(1) serum anion gap
(2) serum osmolar gap
Additional tests that may be order depending on circumstances:
(1) pregnancy test
(2) blood and urine cultures
(3) chest X-ray
(4) abdominal imaging studies
(5) CT brain
(6) serum lipase
(7) serum troponin (in carefully selected patients)
(8) blood alcohol
(9) urine drug testing
(10) screen for toxic alcohols
