Diabetic%20ketoacidosis%20-and-%20hyperosmolar%20hyperglycemic%20state Diagnosis
Evaluation
Diagnostic Criteria for diabetic ketoacidosis (DKA)
- Blood glucose >13.9 mmol/L (>250 mg/dL)
- Arterial pH <7.3 in adults or venous pH <7.3 in pediatrics
- Bicarbonate <15 mEq/L
- Moderate ketonuria or ketonemia
- Anion gap >12
Diagnostic Criteria for hyperosmolar hyperglycemic state (HHS) in Adults
- Blood glucose >33.3 mmol/L (>600 mg/dL)
- Arterial pH >7.3
- Bicarbonate >15 mEq/L
- Mild ketonuria or ketonemia
- Effective serum osmolality >320 mOsm/kg
- Anion gap variable
Diagnostic Criteria for HHS in Pediatrics
- Blood glucose >33.3 mmol/L (>600 mg/dL)
- Venous pH >7.3
- Bicarbonate >15 mEq/L
- Altered mental status or severe dehydration
Classification
Classification of Diabetic Ketoacidosis
- Mild DKA presents without alteration in sensorium, > 250 mg/dL plasma glucose, arterial pH 7.25-7.30, 15-18 mEq/L serum bicarbonate, presence of serum & urine ketones, & >10 anion gap
- Moderate DKA presents w/ or without alteration in sensorium or drowsiness, >250 mg/dL plasma glucose, arterial pH 7-<7.24, 10-<15 mEq/mL serum bicarbonate, presence of serum & urine ketones, & >12 anion gap
- Severe DKA presents w/ stupor or coma, >250 mg/dL plasma glucose, arterial pH <7, <10 mEq/L serum bicarbonate, presence of serum & urine ketones, & >12 anion gap
History
- History of polyuria, polydipsia, polyphagia, weight loss, vomiting, abdominal pain (in DKA)
- Dehydration
- Weakness
Physical Examination
- Altered mental status or sensoria clouding to coma (more frequent in HHS)
- Poor skin turgor, dry axilla & oral mucosa, Kussmaul respirations (in DKA), low jugular venous pressure, tachycardia, hypotension, shock
Laboratory Tests
- Serum glucose
- Blood urea nitrogen (BUN)/creatinine
- Serum ketones
- Electrolytes (anion gap)
- Serum osmolality
- Effective osmolality = (2 × Na) + (glucose/18)
- Urinalysis
- ECG &/or chest X-ray (CXR), if indicated
- Urine ketones by dipstick
- Arterial blood gas
- CBC w/ differential
- Urine, blood & throat culture
- Glycosylated hemoglobin (HbA1c)
- Nitroprusside testing