Paediatric DKA Severity Assessment (ISPAD)
Classifies paediatric DKA severity by the degree of acidosis (ISPAD 2022). Diagnosis also needs glucose > 11 mmol/L and ketonaemia (β-hydroxybutyrate ≥ 3 mmol/L) or moderate/large ketonuria. In the UK follow the BSPED guideline, whose severity bands differ.
Score interpretation
pH ≥ 7.30 and bicarbonate ≥ 18 mmol/L.
→ Not DKA by ISPAD 2022 acid–base criteria; manage hyperglycaemia and ketosis per local protocol and recheck.
pH < 7.3 or bicarbonate < 18 mmol/L (ISPAD 2022).
→ Manage with the BSPED / ISPAD DKA protocol (fluid deficit, insulin infusion and potassium per protocol); hourly observations and neurological checks; watch for cerebral oedema (headache, falling heart rate, rising blood pressure, reduced conscious level).
pH < 7.2 or bicarbonate < 10 mmol/L (ISPAD 2022).
→ Manage with the BSPED / ISPAD DKA protocol (fluid deficit, insulin infusion and potassium per protocol); hourly observations and neurological checks; watch for cerebral oedema (headache, falling heart rate, rising blood pressure, reduced conscious level).
pH < 7.1 or bicarbonate < 5 mmol/L (ISPAD 2022).
→ Manage with the BSPED / ISPAD DKA protocol (fluid deficit, insulin infusion and potassium per protocol); hourly observations and neurological checks; watch for cerebral oedema (headache, falling heart rate, rising blood pressure, reduced conscious level). Senior and PICU review; treat cerebral oedema immediately per protocol (doses from a children's formulary).
Interpretation bands for the Paediatric DKA Severity. Apply clinical judgement and local guidance.
References
- Glaser N et al. ISPAD clinical practice consensus guidelines 2022: diabetic ketoacidosis and hyperglycemic hyperosmolar state. Pediatr Diabetes. 2022;23(7):835-856.
- BSPED Paediatric DKA Guideline 2021.
Related
Curated clinical cross-links plus same-class fallbacks.
- Dexamethasone (Paediatric) · Corticosteroid — Croup / Bacterial Meningitis / Post-Extubation Stridor / Cerebral Oedema
- Insulin (IV Infusion — ICU Glucose Control) · Insulin — ICU Glucose Management
- Insulin (Soluble / Actrapid) · Insulin
- Insulin Glargine · Long-Acting Insulin Analogue (Basal)
- Insulin Aspart · Rapid-Acting Insulin Analogue (Bolus)
- Insulin Detemir · Long-acting Insulin Analogue
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.