DKA Severity Classification
Classifies diabetic ketoacidosis severity in adults by pH, bicarbonate and blood ketones (ADA/EASD/JBDS consensus 2024): the worst variable sets the grade.
Score interpretation
DKA needs blood ketones ≥ 3.0 mmol/L (or urine ketones ≥ 2+) with acidosis (pH < 7.30 or bicarbonate < 18 mmol/L) and glucose ≥ 11.1 mmol/L or known diabetes.
→ Consider other causes (starvation or alcoholic ketoacidosis; hyperosmolar hyperglycaemic state if glucose is very high without ketoacidosis). Euglycaemic DKA (e.g. on an SGLT2 inhibitor) still counts when ketones and acidosis are present.
pH 7.26–7.29 or bicarbonate 15–17.9 mmol/L, ketones 3.0–6.0 mmol/L.
→ Adults (JBDS 2023): 0.9% sodium chloride and a fixed-rate IV insulin infusion (FRIII) 0.1 units/kg/h; continue long-acting insulin; monitor glucose and ketones hourly — target ketone fall ≥ 0.5 mmol/L/h. Children and young people: follow the BSPED paediatric DKA guideline; use a children's formulary.
pH 7.00–7.25 or bicarbonate 10–14.9 mmol/L.
→ Senior review. Adults (JBDS 2023): 0.9% sodium chloride and a fixed-rate IV insulin infusion (FRIII) 0.1 units/kg/h; continue long-acting insulin; monitor glucose and ketones hourly — target ketone fall ≥ 0.5 mmol/L/h. Children and young people: follow the BSPED paediatric DKA guideline; use a children's formulary.
pH < 7.00, bicarbonate < 10 mmol/L or ketones > 6.0 mmol/L.
→ Senior review and level 2/HDU care — JBDS markers of severity also include bicarbonate < 5, potassium < 3.5 on admission, GCS < 12, SpO2 < 92 %, systolic BP < 90 mmHg, pulse > 100 or < 60 and anion gap > 16. Adults (JBDS 2023): 0.9% sodium chloride and a fixed-rate IV insulin infusion (FRIII) 0.1 units/kg/h; continue long-acting insulin; monitor glucose and ketones hourly — target ketone fall ≥ 0.5 mmol/L/h. Children and young people: follow the BSPED paediatric DKA guideline; use a children's formulary.
Interpretation bands for the DKA Severity. Apply clinical judgement and local guidance.
References
- Umpierrez GE et al. Hyperglycemic Crises in Adults With Diabetes: A Consensus Report. Diabetes Care 2024;47:1257-1275.
- Joint British Diabetes Societies (JBDS) Inpatient Care Group. The management of diabetic ketoacidosis in adults. 2023.
Related
Curated clinical cross-links plus same-class fallbacks.
- Sodium Bicarbonate · Alkalising Agent / Electrolyte
- Insulin (IV Infusion — ICU Glucose Control) · Insulin — ICU Glucose Management
- Sodium Bicarbonate 8.4% · Electrolyte Buffer
- Sodium bicarbonate with sodium chloride · Alkalinising IV solution
- Insulin (Soluble / Actrapid) · Insulin
- Insulin Glargine · Long-Acting Insulin Analogue (Basal)
- Diabetic Ketoacidosis (DKA) · JBDS 2013 / Joint British Diabetes Societies; NICE NG17
- Adult Hypoglycaemia (Treated Diabetes) · JBDS-IP (2023): Hospital Management of Hypoglycaemia
- Adrenal Crisis · Society for Endocrinology Emergency Guidance (2024)
- Type 2 Diabetes Management · NICE NG28 2022
- Hyperthyroidism Management · BTA / ETA 2018
- Adrenal Insufficiency · Society of Endocrinology / ESE 2016
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.