Diabetic Ketoacidosis & Hyperosmolar Hyperglycemic State Initial Assessment

History

It is vital to obtain a history of polyuria, polydipsia, polyphagia, weight loss, vomiting, abdominal pain (in DKA), any symptoms of dehydration, and weakness.  

Physical Examination

During the physical examination, it is important to identify if the patient has altered mental status or sensoria clouding to coma (more frequent in HHS). The presence of poor skin turgor, dry axilla and oral mucosa, Kussmaul respirations (in DKA), low jugular venous pressure, tachycardia, hypotension, and shock should all be identified.  

Diagnosis or Diagnostic Criteria

Diagnostic Criteria for DKA  

The following parameters are the diagnostic criteria to diagnose DKA:

• Blood glucose of >13.9 mmol/L (>250 mg/dL) 
• Arterial pH of <7.3 in adults or venous pH of <7.3 in pediatrics
• Bicarbonate of <15 mEq/L
• Moderate ketonuria or ketonemia
• Anion gap of >12

Diagnostic Criteria for HHS in Adults 

The following parameters are the diagnostic criteria to diagnose HHS in adults: 

• Blood glucose of >33.3 mmol/L (>600 mg/dL)
• Arterial pH of >7.3
• Bicarbonate or >18 mEq/L
• Mild ketonuria or ketonemia
• Effective serum osmolality of >320 mOsm/kg
• Anion gap variable

Diagnostic Criteria for HHS in Pediatrics

The following parameters are the diagnostic criteria to diagnose HHS in pediatrics:

• Blood glucose of >33.3 mmol/L (>600 mg/dL)
• Venous pH of >7.3
• Bicarbonate of >15 mEq/L
• Altered mental status or severe dehydration

Diabetic Ketoacidosis & Hyperosmolar Hyperglycemic State_Initial Assesment