DKA | HHS | |||
Mild | Moderate | Severe | ||
Plasma glucose (mg/dL) | >250 | >250 | >250 | >600 |
Plasma glucose (mmol/L) | >13.9 | >13.9 | >13.9 | >33.3 |
Arterial pH | 7.25 to 7.30 | 7.00 to 7.24 | <7.00 | >7.30 |
Serum bicarbonate (mEq/L) | 15 to 18 | 10 to <15 | <10 | >18 |
Urine ketones¶ | Positive | Positive | Positive | Small |
Serum ketones – Nitroprusside reaction | Positive | Positive | Positive | ≤ Small |
Serum ketones – Enzymatic assay of beta hydroxybutyrate (normal range <0.6 mmol/L)Δ | 3 to 4 mmol/L | 4 to 8 mmol/L | >8 mmol/L | <0.6 mmol/L |
Effective serum osmolality (mOsm/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.
* There may be considerable diagnostic overlap between DKA and HHS.
¶ Nitroprusside reaction method.
Δ Many assays for beta hydroxybutyrate can only report markedly elevated values as >6.0 mmol/L.
◊ Calculation: 2[measured Na (mEq/L)] + glucose (mg/dL)/18.
§ Calculation: (Na+) – (Cl– + HCO3–) (mEq/L).Do you want to add Medilib to your home screen?