Diagnosis and Differential Diagnosis of Diabetic Ketoacidosis

In this article, we will discuss the Diagnosis and Differential Diagnosis of Diabetic Ketoacidosis. So, let’s get started.

Diagnosis and Differential Diagnosis

The diagnosis of diabetic ketoacidosis in a patient known to have type 1 diabetes is not difficult, but has to be differentiated in a patient who is not known to be diabetic.

The diabetic ketoacidosis has to be differentiated from CVA, hypoglycemia and hyperosmolar coma due to altered mental status (coma). Uremia and alcohol poisoning have to be differentiated because of presence of metabolic acidosis.

Gastroenteritis has to be differentiated because of nausea, vomiting and signs of dehydration in diabetic ketoacidosis. The first step in diagnosis is to test the urine for glucose and ketones. If urine is negative for ketone, another cause for the acidosis is likely. If it is positive, plasma glucose examination is required to be certain. Hyperglycemia and ketonuria confirm the diagnosis of diabetic ketoacidosis a strongly positive urine dipstick for glucose and ketone.

The ketones may be tested by semiquantitative nitroprusside methods (Ace test and ketorix) in serial dilutions of the plasma. Undiluted plasma may give a strongly positive result when starvation alone is the problem while a strong reaction in dilution exceeding 1:1 is presumptive evidence of ketoacidosis. The causes and diagnosis of ketonuria are given below

Cause of Ketonuria and Diagnosis

  1. Diabetic ketoacidosis- Hyperglycemia with ketonemia/ketonuria
  2. Starvation- Low glucose, normal bicarbonate
  3. Alcoholic ketoacidosis- Normal to low blood glucose and bicarbonate
  4. Salicylate poisoning- Elevated serum salicylate levels. Normal to low blood glucose

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