💧 DKA / HHS Diagnosis and Initial Management
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 / HHS Diagnosis and Initial Management
Glucose (mmol/L)
Arterial pH
HCO₃⁻ (mmol/L)
Blood ketones ≥ 3 or urine ketones moderate-large
Effective plasma osmolality (optional) (mOsm/kg)
When to use
Initial assessment and management framing of diabetic ketoacidosis and the hyperglycemic hyperosmolar state.
How it works
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.
Key points
- 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).
References
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.