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Diagnostic criteria and classification of DKA

Authoring team

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


criterion

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:

  1. Misra S, Oliver NS. Diabetic ketoacidosis in adults. BMJ. 2015 Oct 28;351:h5660.
  2. Joint British Diabetes Societies for Inpatient Care. The Management of Diabetic Ketoacidosis in Adults. Revised March 2023.

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The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

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