Criteria

Diagnose diabetic ketoacidosis (DKA) if a patient has:​[1]​​

  • Diabetes - blood glucose ≥11.1 mmol/L OR known diabetes, AND

  • Ketonaemia - blood ketones (beta-hydroxybutyrate [BOHB]) ≥3 mmol/L OR ketonuria (2+ or more on standard urine sticks), AND

  • Acidosis - bicarbonate (HCO3-) <18 mmol/L AND/OR venous pH <7.3. 

Rarely, patients present with euglycaemic DKA and have a normal blood glucose level.[20][103]

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: ≥11.1 mmol/L

  • Arterial pH: >7.25 to <7.30

  • Serum bicarbonate: 15-18 mmol/L

  • Urine ketones: positive

  • Serum ketones (BOHB): 3-6 mmol/L

  • Mental status: alert

Moderate DKA

  • Plasma glucose: ≥11.1 mmol/L

  • Arterial pH: 7.00 to 7.25

  • Serum bicarbonate: 10 to <15 mmol/L

  • Urine ketones: positive

  • Serum ketones (BOHB): 3-6 mmol/L

  • Mental status: alert and/or drowsy

Severe DKA

  • Plasma glucose: ≥11.1 mmol/L

  • Arterial pH: <7.00

  • Serum bicarbonate: <10 mmol/L

  • Urine ketones: positive

  • Serum ketones (BOHB): >6 mmol/L

  • Mental status: stupor and/or coma

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