Hyperglycemic crises in adult patients with diabetes: a consensus statement from the American Diabetes Association[1]

Plasma glucose (mg/dL)

  • >250 in DKA.

Arterial pH

  • 7.25 to 7.3 in mild DKA

  • 7.00 to <7.24 in moderate DKA

  • <7.00 in severe DKA.

Serum bicarbonate (mEq/L)

  • 15-18 in mild DKA

  • 10-15 in moderate DKA

  • <10 in severe DKA.

Urine and serum ketones (nitroprusside reaction method)

  • + in DKA.

Effective serum osmolality (mOsm/kg)

  • variable in DKA.

Anion gap (mEq/L)

  • >10 in mild DKA

  • >12 in moderate and severe DKA.

Mental status

  • alert in mild DKA

  • alert/drowsy in moderate DKA

  • stupor/coma in severe DKA.[1]

The most widely used diagnostic criteria for DKA are plasma glucose >250 mg/dL, arterial pH <7.3, and presence of ketonemia and/or ketonuria. However, severity of DKA or the required number of criteria for diagnosis have not been officially stated, and the above-mentioned classification has been based heavily on prospective studies of DKA.[1]

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