Diabetic Ketoacidosis Severity
Classifies diabetic ketoacidosis as mild, moderate or severe by pH, bicarbonate and consciousness.
When to use
Adults with confirmed diabetic ketoacidosis, to classify severity and guide the treatment setting.
Pearls and pitfalls
- The classification uses the worst of three criteria: pH, bicarbonate and mental status.
- Severity does not replace assessment of potassium, osmolality and precipitating cause.
- Ketoacidosis can occur with only moderately elevated glucose, especially in pregnancy and SGLT2 inhibitor users.
- Treatment includes volume, insulin and potassium replacement according to serum levels.
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Formula
Severe if pH below 7.00, bicarbonate below 10 mmol/L or stupor/coma; moderate if pH 7.00 to 7.24, bicarbonate 10 to 15 or drowsiness; mild otherwise.
Evidence
Severity classification proposed in the American Diabetes Association review of hyperglycemic crises.
References
- Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN. Hyperglycemic crises in adult patients with diabetes. Diabetes Care. 2009;32(7):1335-1343. doi:10.2337/dc09-9032
Frequently asked questions
What is Diabetic Ketoacidosis Severity?
Classifies diabetic ketoacidosis as mild, moderate or severe by pH, bicarbonate and consciousness. Adults with confirmed diabetic ketoacidosis, to classify severity and guide the treatment setting.
How is the result calculated?
Severe if pH below 7.00, bicarbonate below 10 mmol/L or stupor/coma; moderate if pH 7.00 to 7.24, bicarbonate 10 to 15 or drowsiness; mild otherwise.
How should the result be interpreted?
Severity classification proposed in the American Diabetes Association review of hyperglycemic crises.
What are the sources?
Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN. Hyperglycemic crises in adult patients with diabetes. Diabetes Care. 2009;32(7):1335-1343.