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©2013 UpToDate ® Print Email Diagnostic criteria for diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) DKA HHS Mild Moderate Severe Plasma glucose (mg/dL) >250 >250 >250 >600 Arterial pH 7.25-7.30 7.00-7.24 <7.00 >7.30 Serum bicarbonate (mEq/L) 15-18 10 to <15 <10 >18 Urine ketones* Positive Positive Positive Small Serum ketones* Positive Positive Positive Small Effective serum osmolality (mOsm/kg)• Variable Variable Variable >320 Anion gapΔ >10 >12 >12 Variable Alteration in sensoria or mental obtundation Alert Alert/drowsy Stupor/coma Stupor/coma * Nitroprusside reaction method. • Calculation: 2[measured Na (mEq/L)] + glucose (mg/dL)/18. Δ Calculation: (Na+) - (Cl- + HCO3-) (mEq/L). See text for details. 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.