💧 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.
Clinical takeaway
Fluids first: 0.9% saline 15–20 mL/kg in the first hour, then adjust by sodium and volume; HHS needs larger volumes.
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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.
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| 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 |
→AssessmentDKA 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
| 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 |
→AssessmentDoes 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
Frequently asked questions
- What is 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.
- How is DKA / HHS Diagnosis and Initial Management calculated? What is the core formula?
- 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.
- When is DKA / HHS Diagnosis and Initial Management used?
- Initial assessment and management framing of diabetic ketoacidosis and the hyperglycemic hyperosmolar state.
- What are the key clinical points for DKA / HHS Diagnosis and Initial Management?
- 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).
- What are the limits and cautions when using DKA / HHS Diagnosis and Initial Management?
- 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.
- How is DKA / HHS Diagnosis and Initial Management calculated in practice? Can you show a worked example?
- 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）