Diagnostic Criteria for Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State
|
Mild DKA |
Moderate DKA |
Severe DKA |
HHS |
|
|
Plasma glucose (mg per dL [mmol per L]) |
> 250 (13.9) |
> 250 |
> 250 |
> 600 (33.3) |
|
Arterial pH |
7.25 to 7.30 |
7.00 to 7.24 |
< 7.00 |
> 7.30 |
|
Serum bicarbonate (mEq per L) |
15 to 18 |
10 to < 15 |
< 10 |
> 15 |
|
Urine ketones |
Positive |
Positive |
Positive |
Small |
|
Ketoni u krvi |
Positive |
Positive |
Positive |
Small |
|
Beta-hydroxybutyrate |
High |
High |
High |
Normal or elevated20 |
|
Effective serum osmolality (mOsm per kg)* |
Variable |
Variable |
Variable |
> 320 |
|
Anion gap† |
> 10 |
> 12 |
> 12 |
Variable |
|
Alteration in sensoria or mental obtundation |
Alert |
Alert/drowsy |
Stupor/coma |
Stupor/coma |
DKA =
diabetic ketoacidosis; HHS = hyperosmolar
hyperglycemic state.
*—Effective
serum osmolality = 2 × measured Na (mEq per L) + (glucose [mg per dL]
÷ 18).
†—Anion
gap = Na+ – (Cl– + HCO3– [mEq per L]).
Adapted with permission from Kitabchi
AE, Umpierrez GE, Murphy MB, Barrett EJ, Kreisberg RA, Malone JI, et al. Hyperglycemic crises in
diabetes. Diabetes Care 2004;27(suppl 1):S95, with additional
information from reference 20.