American Diabetes Association

Table 1—

Diagnostic criteria and typical total body deficits of water and electrolytes in DKA and HHS

	DKA				HHS
		Mild	Moderate	Severe	HHS
Diagnostic criteria and classification
Plasma glucose (mg/dl)	>250 mg/dl	>250 mg/dl	>250 mg/dl	>600 mg/dl
Arterial pH	7.25–7.30	7.00 to <7.25	<7.00	>7.30
Serum bicarbonate (mEq/l)	15–18	10 to <15	<10	>15
Urine ketone^*	Positive	Positive	Positive	Small
Serum ketone^*	Positive	Positive	Positive	Small
Effective serum osmolality^†	Variable	Variable	Variable	>320 mOsm/kg
Anion gap^‡	>10	>12	>12	<12
Mental status	Alert	Alert/drowsy	Stupor/coma	Stupor/coma
Typical deficits
Total water (l)	6			9
Water (ml/kg)^§	100			100–200
Na⁺ (mEq/kg)	7–10			5–13
Cl⁻ (mEq/kg)	3–5			5–15
K⁺ (mEq/kg)	3–5			4–6
PO₄ (mmol/kg)	5–7			3–7
Mg⁺⁺ (mEq/kg)	1–2			1–2
Ca⁺⁺ (mEq/kg)	1–2			1–2

	DKA				HHS
		Mild	Moderate	Severe	HHS
Diagnostic criteria and classification
Plasma glucose (mg/dl)	>250 mg/dl	>250 mg/dl	>250 mg/dl	>600 mg/dl
Arterial pH	7.25–7.30	7.00 to <7.25	<7.00	>7.30
Serum bicarbonate (mEq/l)	15–18	10 to <15	<10	>15
Urine ketone^*	Positive	Positive	Positive	Small
Serum ketone^*	Positive	Positive	Positive	Small
Effective serum osmolality^†	Variable	Variable	Variable	>320 mOsm/kg
Anion gap^‡	>10	>12	>12	<12
Mental status	Alert	Alert/drowsy	Stupor/coma	Stupor/coma
Typical deficits
Total water (l)	6			9
Water (ml/kg)^§	100			100–200
Na⁺ (mEq/kg)	7–10			5–13
Cl⁻ (mEq/kg)	3–5			5–15
K⁺ (mEq/kg)	3–5			4–6
PO₄ (mmol/kg)	5–7			3–7
Mg⁺⁺ (mEq/kg)	1–2			1–2
Ca⁺⁺ (mEq/kg)	1–2			1–2

Nitroprusside reaction method.

†

Calculation of effective serum osmolality: 2[measured Na⁺ (mEq/l)] + [glucose (mg/dl)]/18.

‡

Calculation of anion gap: (Na⁺) − [Cl⁻ + HC0₃⁻ (mEq/l)].

Per kg body wt. Data adapted from refs. 1, 4, and 7.