What is the pH ?
If not already done, address potassium and sodium:
“Serum pH is a diagnostic criterion for DKA and helps distinguish DKA from HHS. Traditionally, arterial blood gas (ABG) measurements have been used to determine serum pH, and current guidelines still suggest ABG analysis.1 However, obtaining an ABG requires a painful procedure that is not without some risk, including arterial bleeding and nerve damage. Ma et al investigated whether ABGs provided useful information that was not available from venous blood samples and found that venous pH correlated very strongly with arterial pH (r = 0.95). Based on this study, the venous pH would typically be less than the arterial pH by an average of 0.015 (confidence interval [CI], ± 0.006 pH units). ABG analysis changed diagnosis in 1% of patients, changed treatment in 3.5% of patients, and changed disposition in only 1% of patients. For most patients, emergency clinicians can forego ABG testing during evaluation of hyperglycemic emergencies and can instead use the venous blood gas (VBG) to determine serum pH unless the patient is in profound hypovolemic shock.”