DKA / HHS Diagnosis and Initial Management — free guideline decision tool

Discriminate DKA from HHS by glucose, blood gas, ketones and osmolality, and grade DKA severity, with the fluid/insulin/potassium plan. Instant, browser-side.

DKA: glucose > 13.9 + ketones positive + pH < 7.3 or HCO₃⁻ < 18; severity by pH/HCO₃⁻ (mild 7.25–7.30 / 15–18, moderate 7.0–7.24 / 10–15, severe < 7.0 / < 10). HHS: glucose ≥ 33.3 + effective osmolality > 320 + no significant acidosis/ketosis. The two can coexist.

Initial assessment and management framing of diabetic ketoacidosis and the hyperglycemic hyperosmolar state.

Fluids first: 0.9% saline 15–20 mL/kg in the first hour, then adjust by sodium and volume; HHS needs larger volumes. Insulin 0.1 U/kg bolus then 0.1 U·kg⁻¹·h⁻¹; add dextrose and reduce the rate once glucose reaches 11.1 (DKA) / 16.7 (HHS). Potassium: replace if K < 5.2 with adequate urine output; if K < 3.3 give potassium first and withhold insulin until ≥ 3.3. Bicarbonate generally not given (consider only pH < 7.0); always find and treat the trigger (infection most common).

For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.

Inputs: Glucose 28 mmol/L, Arterial pH 7.15, HCO₃⁻ 12 mmol/L, Blood ketones ≥ 3 or urine ketones moderate-large Yes, Effective plasma osmolality (optional) 330 mOsm/kg → Result: Assessment DKA with hyperosmolarity (mixed)（Diagnostic points: DKA: glucose > 13.9 + blood/urine ketones positive + pH < 7.3 or HCO₃⁻ < 18; HHS: glucose ≥ 33.3 + effective osmolality > 320 + pH > 7.3, HCO₃⁻ > 18, no significant ketosis, Fluids: 0.9% saline first-line, 15–20 mL/kg in the first hour (~ 1–1.5 L), then adjust by sodium and volume; HHS has greater water deficit and needs larger volumes, Insulin: 0.1 U/kg IV bolus then 0.1 U·kg⁻¹·h⁻¹ infusion; if glucose falls < 10% in the first hour give 0.14 U/kg then continue infusion; when glucose reaches 11.1 (DKA)/16.7 (HHS) switch to dextrose-containing fluid and reduce to 0.02–0.05） Inputs: Glucose 28 mmol/L, Arterial pH 7.15, HCO₃⁻ 12 mmol/L, Blood ketones ≥ 3 or urine ketones moderate-large No/weak, Effective plasma osmolality (optional) 330 mOsm/kg → Result: Assessment Does not meet typical DKA/HHS criteria — re-evaluate clinically（Diagnostic points: DKA: glucose > 13.9 + blood/urine ketones positive + pH < 7.3 or HCO₃⁻ < 18; HHS: glucose ≥ 33.3 + effective osmolality > 320 + pH > 7.3, HCO₃⁻ > 18, no significant ketosis, Fluids: 0.9% saline first-line, 15–20 mL/kg in the first hour (~ 1–1.5 L), then adjust by sodium and volume; HHS has greater water deficit and needs larger volumes, Insulin: 0.1 U/kg IV bolus then 0.1 U·kg⁻¹·h⁻¹ infusion; if glucose falls < 10% in the first hour give 0.14 U/kg then continue infusion; when glucose reaches 11.1 (DKA)/16.7 (HHS) switch to dextrose-containing fluid and reduce to 0.02–0.05）