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Typical laboratory characteristics of diabetic ketoacidosis and hyperosmolar hyperglycemic state*

Typical laboratory characteristics of diabetic ketoacidosis and hyperosmolar hyperglycemic state*
  DKA HHS
Mild Moderate Severe
Plasma glucose (mg/dL) >250 >250 >250 >600
Plasma glucose (mmol/L) >13.9 >13.9 >13.9 >33.3
Arterial pH 7.25 to 7.30 7.00 to 7.24 <7.00 >7.30
Serum bicarbonate (mEq/L) 15 to 18 10 to <15 <10 >18
Urine ketones Positive Positive Positive Small
Serum ketones – Nitroprusside reaction Positive Positive Positive ≤ Small
Serum ketones – Enzymatic assay of beta hydroxybutyrate (normal range <0.6 mmol/L)Δ 3 to 4 mmol/L 4 to 8 mmol/L >8 mmol/L <0.6 mmol/L
Effective serum osmolality (mOsm/kg) Variable Variable Variable >320
Anion gap§ >10 >12 >12 Variable
Alteration in sensoria or mental obtundation Alert Alert/drowsy Stupor/coma Stupor/coma

DKA: diabetic ketoacidosis; HHS: hyperosmolar hyperglycemic state.

* There may be considerable diagnostic overlap between DKA and HHS.

¶ Nitroprusside reaction method.

Δ Many assays for beta hydroxybutyrate can only report markedly elevated values as >6.0 mmol/L.

◊ Calculation: 2[measured Na (mEq/L)] + glucose (mg/dL)/18.

§ Calculation: (Na+) – (Cl– + HCO3–) (mEq/L).
Copyright © 2006 American Diabetes Association. From Diabetes Care Vol 29, Issue 12, 2006. Information updated from Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN. Hyperglycemic crises in adult patients with diabetes. Diabetes Care 2009; 32:1335. Reprinted with permission from the American Diabetes Association.
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