Labs
Anion gap acidosis
Typically wide anion gap
Positive serum ketones + lactic acidosis
Lab measured ketone is acetoacetate
May miss beta-hydroxybutyrate
Urine ketones may be falsely negative or low
Typically normal osmolal gap
Alcohol level usually zero or not considerably high
BMP, Mg/phos
Often have concomitant electrolyte abnormalities
Anion gap acidosis
Typically wide anion gap
Positive serum ketones + lactic acidosis
Lab measured ketone is acetoacetate
May miss beta-hydroxybutyrate
Urine ketones may be falsely negative or low
Typically normal osmolal gap
Alcohol level usually zero or not considerably high
BMP, Mg/phos
Often have concomitant electrolyte abnormalities
Typically wide anion gap
Positive serum ketones + lactic acidosis
Lab measured ketone is acetoacetate
May miss beta-hydroxybutyrate
Urine ketones may be falsely negative or low
Lab measured ketone is acetoacetate
May miss beta-hydroxybutyrate
Urine ketones may be falsely negative or low
Often have concomitant electrolyte abnormalities
ECG
May show dysrhythmias or QT interval/QRS changes secondary to electrolyte abnormalities
May show dysrhythmias or QT interval/QRS changes secondary to electrolyte abnormalities
Imaging
Consider CXR if concern for aspiration pneumonia
Consider CT head if presentation associated with trauma
Consider CXR if concern for aspiration pneumonia
Consider CT head if presentation associated with trauma
Alcoholic ketoacidosis
Isopropyl Alcohol
Diabetic ketoacidosis 
Results in ketosis
Diabetic ketoacidosis
Methanol, Ethylene Glycol
Starvation ketoacidosis
Do not produce ketosis