Diabetic ketoacidosis classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [2]

Overview

Diabetic ketoacidosis (DKA) may be classified according to severity into mild, moderate and severe DKA. The classification takes into account various parameters for example, arterial pH, anion gap, effective serum osmolarity, mental status, serum bicarbonate levels and serum ketone levels. Classification of DKA has important implications in the management of the disease.

Classification

Classification based on severity

Diabetic ketoacidosis (DKA) may be classified according to severity into the following types:[1][2]

  • Mild DKA
  • Moderate DKA
  • Severe DKA

Shown below is a table summarizing the diagnosis of Diabetic ketoacidosis according the the American Diabetes Association (ADA) guidelines. [3] [4]

VARIABLE DIABETIC KETOACIDOSIS
MILD (Plasma Glucose > 250mg/dL or 13.88 mmol/L) MODERATE (Plasma Glucose > 250mg/dL or 13.88 mmol/L) SEVERE (Plasma Glucose > 250mg/dL or 13.88 mmol/L)
Arterial pH 7.25 to 7.30 7.00 to < 7.24 < 7.00
Serum bicarbonate 15 to 18 mEq/L 10 to < 15 mEq/L < 10 mEq/L
Urine ketone (Nitroprusside reaction method) Positive Positive Positive
Serum ketone (Nitroprusside reaction method) Positive Positive Positive
Effective serum osmolality Variable Variable Variable
Anion gap > 10 mEq/L (10 mmol/L) > 12 mEq/L (12 mmol/L) > 12 mEq/L (12 mmol/L)
Mental status Alert Alert/drowsy Stupor/coma

References

  1. "Diabetic Ketoacidosis - Endotext - NCBI Bookshelf".
  2. "Diabetic Ketoacidosis - American Family Physician".
  3. Schmoldt A, Benthe HF, Haberland G (1975). "Digitoxin metabolism by rat liver microsomes". Biochem Pharmacol. 24 (17): 1639–41. PMID doi.org/10.2337/dc09-9032 Check |pmid= value (help).
  4. Kitabchi AE, Umpierrez GE, Murphy MB, Barrett EJ, Kreisberg RA, Malone JI; et al. (2001). "Management of hyperglycemic crises in patients with diabetes". Diabetes Care. 24 (1): 131–53. doi:10.2337/diacare.24.1.131. PMID 11194218.

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