Diagnosis

Diabetic ketoacidosis (DKA) is diagnosed when:

  • Blood glucose is >11 mmol/L
  • Capillary pH is <7.3 and/or capillary bicarbonate is <15 mmol/L
  • Ketones are present in the blood and/or urine

Hyperglycemic hyperosmolar state (HHS) should be suspected when:

  • Hyperglycemia (>33 mmol/L) extremely high blood glucose levels, a hallmark of HHS.
  • Hyper-osmolality (>330 mOsm/L) elevated serum osmolality, which reflects significant dehydration and concentration of solutes due to hyperglycemia.
  • Little to no ketoacidosis

 Mixed picture of DKA and HHS is possible

BCCH Endocrinology Department - Endocrinologist. DIABETIC KETOACIDOSIS MEDICAL PROTOCOL [Internet]. 2024. Available from: https://shop.healthcarebc.ca/phsa/BCWH_2/BC%20Children%27s%20Hospital/C-05-13-60395.pdf 

Neurological Observation in DKA

Follow Glasgow Coma Scale

Image
DKA Glasgow Coma Scale
  • Severe headache, change in sensorium or BP, dilated pupils, bradycardia, irregular
    breathing, posturing and incontinence are signs of impending deterioration. 

Rapid intervention is imperative:

  • Airway / breathing / circulation
  • Elevate head of bed
  • Decrease all fluid bags to 5 mL/h pending physician reassessment
  • Mannitol 20% (0.5–1 g/kg, 2.5–5 mL/kg IV over 15 min) or NaCl 3% (2.5–5 mL/kg
    IV over 15 min)
  • Consider intubation and mild hyperventilation (keep pCO2 >22 mg Hg) for
    impending respiratory failure
  • Arrange CT when stable

BCCH Child & Youth Health Policy and Procedure Manual. APPENDIX A: MODIFIED GLASGOW COMA SCALE (GCS) FOR INFANTS AND CHILDREN [Internet]. Available from: https://shop.healthcarebc.ca/phsa/BCWH_2/BC%20Children%27s%20Hospital/C-05-14-62116.pdf