π©Ί Diabetic Ketoacidosis (DKA) Calculator
Diagnose and classify DKA severity using ADA criteria, or assess DKA mortality risk. Choose a mode below.
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What Is Diabetic Ketoacidosis?
Diabetic Ketoacidosis (DKA) is a serious, acute complication of diabetes that occurs when three conditions combine:
- Hyperglycemia β Serum glucose > 250 mg/dL
- Acidosis β Arterial blood pH < 7.3 and bicarbonate < 15 mEq/L
- Ketosis β Presence of ketones in blood and/or urine
DKA mainly occurs in type 1 diabetes and is often the very first presentation of the disease. The underlying cause is insufficient insulin to meet the body's metabolic needs.
How Does Diabetes Cause Acidosis?
Without insulin, glucose cannot enter cells for energy. The body responds by:
- Releasing counter-regulatory hormones (epinephrine, cortisol, glucagon), further raising blood sugar
- Breaking down glycogen in the liver, producing more glucose
- Breaking down fats and proteins as alternative energy sources
Fat breakdown produces ketones (Ξ²-hydroxybutyric acid, acetoacetic acid, acetone). Excess ketones make the blood acidic. The lungs compensate with Kussmaul breathing β rapid, deep breathing to expel COβ. The body also exchanges HβΊ ions for KβΊ ions, causing hyperkalemia.
DKA Diagnostic Criteria
| Criteria | Mild DKA | Moderate DKA | Severe DKA |
|---|---|---|---|
| Serum Glucose | > 250 mg/dL | > 250 mg/dL | > 250 mg/dL |
| Anion Gap | β€ 12 mEq/L | > 12 mEq/L | > 12 mEq/L |
| Arterial pH | 7.24 β 7.30 | 7.00 β 7.24 | < 7.00 |
| Serum Bicarbonate | 15 β 18 mEq/L | 10 β < 15 mEq/L | < 10 mEq/L |
| Ketones | Present | Present | Present |
| Mental Status | Alert | Alert / Drowsy | Stupor / Coma |
DKA Symptoms
- Fatigue, tiredness, and sleepiness
- Frequent urination
- Mouth dryness and excessive thirst
- Abdominal and chest pain
- Nausea and vomiting
- Rapid heart rate (tachycardia)
- Low blood pressure (hypotension)
- Kussmaul breathing (rapid, deep breathing)
- Dehydration signs
- Sweet, fruity breath odor (acetone)
Anion Gap in DKA
The anion gap measures the difference between measured cations and anions in blood:
In DKA, the anion gap increases due to excess ketones. A higher anion gap indicates more severe DKA.
DKA Mortality
DKA mortality rate varies from 0.2% to 2%. Poor prognostic signs include significant comorbidities, high insulin requirements, altered mental status, and persistent fever after treatment.
Frequently Asked Questions
What is euglycemic DKA?
A rare form of DKA where ketoacidosis occurs without hyperglycemia (normal blood glucose). It's often related to SGLT-2 inhibitors (e.g., dapagliflozin) and can be difficult to diagnose due to its unusual presentation.
Why is potassium high in DKA?
The body compensates for acidosis by pushing HβΊ ions into cells in exchange for KβΊ ions. This exchange causes potassium to accumulate in the bloodstream (hyperkalemia).
Why is bicarbonate low in DKA?
Excess ketones dissociate, releasing HβΊ ions that bind to bicarbonate (HCOββ»), forming carbonic acid. This consumption depletes bicarbonate levels.
What is the difference between ketosis and ketoacidosis?
Ketosis is the normal presence of ketones in blood (e.g., during fasting). Ketoacidosis is a pathological state where ketone levels are so high they change blood pH to dangerously acidic levels.