Diabetic ketoacidosis laboratory findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Laboratory findings consistent with the diagnosis of diabetic ketoacidosis (DKA) include blood pH < 7.3, serum bicarbonate < 18 mEq/L, anion gap > 10 mEq/L and increased serum osmolarity.

Laboratory Findings

The following lab abnormalities may be found in diabetic ketoacidosis (DKA):

LAB	FORMULA/ VARIABLE	PURPOSE	NORMAL VALUE	VALUE IN DKA
Arterial blood gas	Blood pH	Evaluation of acid-base status of the body	7.35-7.45	<7.3
	Serum bicarbonate		22-26 mEq/L	<18 mEq/L
	Arterial CO2		35-45 mmHg	Decreased secondary to hyperventilation as a compensation to metabolic acidosis
	Arterial O2		75-100 mmHg	Within normal range unless there is concomitant respiratory infection e.g. pneumonia leading to hypoxia)
Anion gap	Na– (Cl + HCO3)	Evaluation of acid base disorders	7 to 13 mEq/L (7 to 13 mmol/L)	Increased (>10 mEq/L required for diagnosis)
Osmolar gap	Osmolality (measured) – osmolality (calculated)	Difference between measured osmolality and calculated osmolality	< 10 mmol/L	Increased
Serum osmolality	2(Na + K) + (glucose/18) + (blood urea nitrogen/2.8)	Measure of particles in a fluid compartment	285 to 295 mOsm/kg (285 to 295 mmol/kg) of water	Increased
Serum sodium correction	Na + 0.016(glucose – 100)	Hyperglycemia causes pseudohyponatremia	135 to 140 mEq per L (135 to 140 mmol per L)	N/A
Blood urea nitrogen, creatinine levels	N/A	To assess renal function	7-20 mg/dl 0.8-1.2mg/dl	Increased (Dehydration and decreased renal perfusion)
Complete blood count (with differential)	N/A	Assess infection To rule out pancreatitis		Increased

Deficits in diabetic ketoacidosis

The following deficits may be seen in mild DKA:

• Total water (L): 6
• Water (mL/kg): 100
• Na+ (mEq/kg): 7 to 10
• Cl- (mEq/kg): 3 to 5
• K+ (mEq/kg): 3 to 5
• PO4 (mmol/kg): 5 to 7
• Mg++ (mEq/kg): 1 to 2
• Ca++ (mEq/kg): 1 to 2