27th May 2025

Diagnostic criteria

The diagnosis of DKA should be made considering the clinical presentation, investigations and diagnostic criteria.

Three criteria must be met to diagnose DKA:

• Hyperglycaemia: blood glucose >11mmol/L OR known diabetes AND
• Ketonaemia: blood ketones >3mmol/L OR ketonuria (2+ or more on standard urine sticks) AND
• Acidosis: bicarbonate <15mmol/L AND/OR venous pH <7.3

Patients with DKA can become critically unwell, consider cardiac monitoring and escalate to a senior and consider critical care support if the patient has any of the following parameters:

• Persistent hypotension (systolic blood pressure <90mmHg) or oliguria (<0.5ml/kg/hr)  despite treatment with intravenous fluids 
• Tachycardia (heart rate >100bpm) or bradycardia (heart rate 60bpm)
• Oxygen saturations <92% on room air 
• Glasgow Coma Scale (GCS) <12 
• Potassium <3.5mmol/L on admission 
• Blood ketones >6mmol/L
• Venous pH <7 
• Venous bicarbonate <5mmol/L
• Anion gap >16
• The patient has kidney failure, is pregnant or other co-morbidities

Each trust has their own guidelines outlining when to escalate to critical care and these should be followed locally.