Criteria

Hyperglycemic crises in adults with diabetes: a consensus report[1]

ALL three of the following must be present to make the diagnosis of diabetic ketoacidosis (DKA):

  1. Diabetes or hyperglycemia: glucose ≥200 mg/dL (≥11.1 mmol/L) OR prior history of diabetes

  2. Ketosis: beta-hydroxybutyrate concentration ≥3 mmol/L OR urine ketone strip 2+ or greater

  3. Metabolic acidosis: pH <7.3 and/or bicarbonate concentration <18 mEq/L (<18 mmol/L)

Clinical DKA classification[1]

Not all variables need to be fulfilled for DKA to be defined as mild, moderate or severe.

Mild DKA

  • Plasma glucose: ≥200 mg/dL (≥11.1 mmol/L)

  • Arterial pH: >7.25 to <7.30

  • Serum bicarbonate: 15-18 mEq/L (15-18 mmol/L)

  • Urine ketone: positive

  • Serum ketone: beta-hydroxybutyrate 3-6 mmol/L

  • Mental status: alert

Moderate DKA

  • Plasma glucose: ≥200 mg/dL (≥11.1 mmol/L)

  • Arterial pH: 7.00 to 7.25

  • Serum bicarbonate: 10 to <15 mEq/L (10 to <15 mmol/L)

  • Urine ketone: positive

  • Serum ketone: beta-hydroxybutyrate 3-6 mmol/L

  • Mental status: alert and/or drowsy

Severe DKA

  • Plasma glucose: ≥200 mg/dL (≥11.1 mmol/L)

  • Arterial pH: <7.00

  • Serum bicarbonate: <10 mEq/L (<10 mmol/L)

  • Urine ketone: positive

  • Serum ketone: beta-hydroxybutyrate >6 mmol/L

  • Mental status: stupor and/or coma

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