Diabetic ketoacidosis (DKA) and hyperosomolar hyperglycemic state (HHS) share a high plasma glucose concentration but differ in important features. Diabetic ketoacidosis can be graded based on the severity of its changes.
Parameters:
(1) arterial pH
(2) serum bicarbonate in mEq/L (= mmol/L)
(3) urine and/or serum ketone
(4) anion gap
(5) mental status
In diabetic ketoacidosis the plasma glucose is > 250 mg/dL
Parameter
Mild DKA
Moderate DKA
Severe DKA
arterial pH
7.25 to 7.30
7.00 to 7.24
< 7.00
serum bicarbonate
15 to 18
10 to 14.9
< 10
ketones
positive
positive
positive
anion gap
> 10
> 12
> 12
mental status
alert
alert to drowsy
stupor or coma
Features of hyperosmolar hyperglycemia state:
(1) plasma glucose > 600 mg/dL with high serum osmolality (> 320 mOsm per kg water)
(2) arterial pH > 7.30
(3) serum bicarbonate > 18 mEq/L
(4) trace ketones in urine and/or blood
(5) stupor or coma
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