Diabetic ketoacidosis laboratory findings

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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):[1][2][3][4][5][6][7]

Arterial blood gas
  • 7.35-7.45
  • <7.3
  • 22-26 mEq/L
  • <18 mEq/L
  • 35-45 mmHg
  • 75-100 mmHg
Anion gap
  • Na– (Cl + HCO3)
  • 7 to 13 mEq/L (7 to 13 mmol/L)
  • Increased (>10 mEq/L required for diagnosis)
Osmolar gap
  • < 10 mmol/L
  • Increased
Serum osmolality
  • 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)
  • 135 to 140 mEq per L (135 to 140 mmol per L)
  • N/A
Blood urea nitrogen, creatinine levels
  • N/A
  • 7-20 mg/dl
  • 0.8-1.2mg/dl
Complete blood count (with differential)
  • N/A
  • Increased

Deficits in diabetic ketoacidosis

The following deficits may be seen in mild DKA:[8]

  • 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


  1. Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN (2009). "Hyperglycemic crises in adult patients with diabetes". Diabetes Care. 32 (7): 1335–43. doi:10.2337/dc09-9032. PMC 2699725. PMID 19564476.
  2. Chiasson JL, Aris-Jilwan N, Bélanger R, Bertrand S, Beauregard H, Ekoé JM, Fournier H, Havrankova J (2003). "Diagnosis and treatment of diabetic ketoacidosis and the hyperglycemic hyperosmolar state". CMAJ. 168 (7): 859–66. PMC 151994. PMID 12668546.
  3. Liamis G, Liberopoulos E, Barkas F, Elisaf M (2014). "Diabetes mellitus and electrolyte disorders". World J Clin Cases. 2 (10): 488–96. doi:10.12998/wjcc.v2.i10.488. PMC 4198400. PMID 25325058.
  4. Adrogué HJ, Lederer ED, Suki WN, Eknoyan G (1986). "Determinants of plasma potassium levels in diabetic ketoacidosis". Medicine (Baltimore). 65 (3): 163–72. PMID 3084904.
  5. Xu W, Wu HF, Ma SG, Bai F, Hu W, Jin Y, Liu H (2013). "Correlation between peripheral white blood cell counts and hyperglycemic emergencies". Int J Med Sci. 10 (6): 758–65. doi:10.7150/ijms.6155. PMC 3638300. PMID 23630441.
  6. Molitch ME, Rodman E, Hirsch CA, Dubinsky E (1980). "Spurious serum creatinine elevations in ketoacidosis". Ann. Intern. Med. 93 (2): 280–1. PMID 6773457.
  7. Gokel Y, Paydas S, Koseoglu Z, Alparslan N, Seydaoglu G (2000). "Comparison of blood gas and acid-base measurements in arterial and venous blood samples in patients with uremic acidosis and diabetic ketoacidosis in the emergency room". Am. J. Nephrol. 20 (4): 319–23. doi:13607 Check |doi= value (help). PMID 10970986.
  8. Kitabchi AE, Umpierrez GE, Murphy MB, Barrett EJ, Kreisberg RA, Malone JI, Wall BM (2001). "Management of hyperglycemic crises in patients with diabetes". Diabetes Care. 24 (1): 131–53. PMID 11194218.

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