This single center study looked at diabetic patients who had a POC glucose over 300 and POC ketone over 1.1 and reviewed their diagnosis vs the laboratory accepted diagnosis of DKA.
“The most recent international consensus laboratory definition of (non-euglycemic) DKA includes a glucose of >?250; a pH <?7.3 or a bicarbonate ??18?mmol/L; and a beta-hydroxybutyrate (BOHB) ??3.0?mmol/L or urine ketone strip ??2+”
Additional Information
They found that 53% met the laboratory definition of DKA.
Of the remainder:
“Of 740 screening positive by POC testing whose initial labs did not meet DKA criteria, 229 (31%, 95% CI: 28, 34) were diagnosed with DKA. Primary ED diagnoses of the remaining 511 included: hyperglycemia (196, 38%), starvation ketosis (58, 11%), hyperosmotic hyperglycemic state (11, 2%), and other ketosis (9, 2%), while 67 (13%) had a primary diagnosis of infection, 1 (<?1%) metabolic acidosis and 169 (33%) an unrelated diagnosis.”
Their conclusion was EPs diagnose DKA even when lab work doesn’t support the diagnosis as it is a clinical not a lab diagnosis. Most importantly these patients are getting insulin and fluid to correct their underlying metabolic derangement.
References
R. T.Griffey, N.Haas, R. M.Schneider, et al., “How Often Are Emergency Patients Diagnosed With Diabetic Ketoacidosis Despite Not Meeting Laboratory Criteria?,” Academic Emergency Medicine33, no. 5 (2026): e70315, https://doi.org/10.1111/acem.70315.