Question 1

What are the diagnostic criteria for DKA?

Accepted Answer

DKA requires all three: blood glucose >250 mg/dL (though can be lower in euglycemic DKA), arterial pH <7.3 or serum bicarbonate <18 mEq/L, and positive serum or urine ketones. Severity is classified as mild (pH 7.25-7.30), moderate (7.00-7.24), or severe (<7.00).

Question 2

Why is potassium replacement critical in DKA management?

Accepted Answer

Insulin drives potassium intracellularly, rapidly dropping serum levels. Despite normal or high initial potassium (due to acidosis-driven extracellular shift), total body potassium is depleted. Insulin must be held until potassium is ≥3.5 mEq/L to prevent life-threatening hypokalemia and cardiac arrhythmias.

Question 3

What is euglycemic DKA?

Accepted Answer

Euglycemic DKA occurs with glucose <250 mg/dL, increasingly recognized with SGLT2 inhibitor use (empagliflozin, dapagliflozin). The glucosuria from SGLT2 inhibitors masks hyperglycemia while ketogenesis continues. Clinicians must maintain a high index of suspicion in diabetic patients on these medications presenting with acidosis.

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