Diagnostic criteria and classification of DKA
Diagnostic criteria
The diagnostic criteria for diabetic ketoacidosis are: (1,2)
- ketonaemia 3 mmol /l and over or significant ketonuria (more than 2 + on standard urine sticks)
- blood glucose over 11 mmol /l or known diabetes mellitus
- venous bicarbonate (HCO3 ) ) below 15 mmol /l and /or venous pH less than 7.3
The American Diabetes Association diagnostic criteria for DKA are as follows:
- elevated serum glucose level (greater than 250 mg per dL [13.88 mmol per L])
- an elevated serum ketone level
- a pH less than 7.3 and
- a serum bicarbonate level less than 18 mEq per L (18 mmol per L)
Classification of diabetic ketoacidosis
DKA can be classified according to the severity into mild, moderate and severe
| mild (serum glucose > 250 mg/dL [13.88 mmol/L]) | moderate (serum glucose > 250 mg/dL) | severe (serum glucose > 250 mg/dL) |
anion gap | > 10 mEq/L (10 mmol/L) | > 12 mEq/L (12 mmol/L) | > 12 mEq/L (12 mmol/L) |
arterial pH | 7.24 to 7.30 | 7.00 to < 7.24 | < 7.00 |
effective serum osmolality | variable | variable | variable |
mental status | alert | alert/drowsy | stupor/coma |
serum bicarbonate | 15 to 18 mEq/L (15 to 18 mmol/L) | 10 to < 15 mEq/L (10 to < 15 mmol/L) | < 10 mEq/L (10 mmol/L) |
serum ketone | positive | positive | positive |
urine ketone | positive | positive | positive |
Reference:
- Misra S, Oliver NS. Diabetic ketoacidosis in adults. BMJ. 2015 Oct 28;351:h5660.
- Joint British Diabetes Societies for Inpatient Care. The Management of Diabetic Ketoacidosis in Adults. Revised March 2023.
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