When you begin to treat DKA, it paradoxically appears to get worse on urinalysis before getting better.
WHY? Serum ketones will become more positive as keotacidosis is treated, because B-OH butyrate (not measured) and Acetoacetate (measured) will be converted to Acetone (measured, but not an acid)
References
1. Gosmanov, A. R., Gosmanova, E. O., & Dillard-Cannon, E. (2014). Management of adult diabetic ketoacidosis. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 7, 255–264. http://doi.org/10.2147/DMSO.S50516
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