A patient with diabetic ketoacidosis should show resolution abnormal laboratory tests with appropriate therapy. Failure of one or more of these measures to improved may indicate an underlying problem that needs to be addressed.

With appropriate resuscitation a patient with diabetic ketoacidosis should:

(1) have normalization of the blood pH

(2) narrowing of the anion gap into the normal range

(3) normalization of the serum bicarbonate concentration


Differential diagnosis for a failure for these measures to resolve:

(1) inadequate fluid resuscitation

(2) inadequate insulin delivery (inadequate dose, line infiltration, infusion pump error)

(3) insulin resistance

(3a) associated with persistent acidosis (non-anion gap metabolic acidosis, other)

(3b) immune-based (anti-insulin antibodies; antibodies to insulin receptor)

(4) unresolved underlying condition (infection, malnutrition, AMI, etc)


It is important to identify the causes and to treat them. If the problems have been resolved, then there should be an improvement in acid-base measures.

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