diagnostic criteria and classification of DKA
Last reviewed 06/2022
diagnostic criteria
The diagnostic criteria for diabetic ketoacidosis are:
- 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 (1)
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) (2)
classification of diabetic ketoacidosis
DKA can be classified according to the severity into mild, moderate and severe (2)
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 |
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