DKA Assessment Calculator
Calculate the anion gap and classify diabetic ketoacidosis severity — mild, moderate, or severe — from glucose, arterial pH, and serum bicarbonate, using standard diagnostic criteria.
How to Use This Calculator
- Enter blood glucose in mg/dL.
- Enter arterial pH and serum bicarbonate from the blood gas / metabolic panel.
- Enter sodium and chloride so the anion gap can be calculated.
- Read the result: the DKA severity grade (by the more severe of pH and bicarbonate) and the anion gap.
This explains the diagnostic numbers; it does not diagnose DKA. Ketones and clinical assessment are still required, and treatment must be in hospital.
How DKA Is Assessed
Diabetic ketoacidosis is defined by the triad of hyperglycemia (usually >250 mg/dL), high anion-gap metabolic acidosis, and ketosis. Severity is graded mainly by how low the arterial pH and serum bicarbonate are. The anion gap measures unmeasured acids (ketones) in the blood:
A normal gap is about 8–12 mEq/L. In DKA the gap is elevated, reflecting ketoacid build-up.
DKA Severity Criteria (ADA)
| Severity | Arterial pH | Bicarbonate (mEq/L) | Mental status |
|---|---|---|---|
| Mild | 7.25–7.30 | 15–18 | Alert |
| Moderate | 7.00–7.24 | 10–<15 | Alert/drowsy |
| Severe | <7.00 | <10 | Stupor/coma |
All grades use glucose >250 mg/dL, positive ketones, and an elevated anion gap. This tool grades by pH/bicarbonate, taking the more severe of the two.
Recognizing DKA: Symptoms & Triggers
Warning signs
DKA usually builds with excessive thirst and frequent urination, then nausea, vomiting and abdominal pain, weakness, a fruity (acetone) smell on the breath, deep rapid "Kussmaul" breathing, and — as it worsens — confusion or drowsiness. Any of these in someone with diabetes, especially with high glucose and ketones, is an emergency.
Common triggers
The most frequent precipitant is infection or acute illness. Others include missed or insufficient insulin, a new diagnosis of type 1 diabetes, insulin pump failure (no long-acting depot to fall back on), and SGLT2 inhibitor use, which can cause euglycemic DKA at near-normal glucose.
Frequently Asked Questions
How is DKA severity classified?
DKA is graded mild, moderate, or severe mainly by arterial pH and serum bicarbonate, alongside mental status. Lower pH and bicarbonate, and reduced alertness, indicate more severe DKA.
What anion gap indicates DKA?
A normal anion gap is roughly 8–12 mEq/L. In DKA the gap is elevated above this because ketoacids accumulate. The gap is calculated as sodium minus the sum of chloride and bicarbonate.
Is this the same as the DKA insulin drip calculator?
No. This tool assesses the diagnosis and severity from lab values. For the IV insulin infusion rate used during treatment, see our DKA insulin drip calculator. Both are inpatient educational references.
Can DKA happen with near-normal glucose?
Yes. Euglycemic DKA — ketoacidosis with glucose under about 250 mg/dL — can occur, notably with SGLT2 inhibitors, pregnancy, or reduced intake. It still needs urgent treatment, so clinical judgement matters more than glucose alone.
How quickly can DKA develop?
It can develop in under 24 hours, and faster in type 1 diabetes — especially with an insulin pump failure, where there is no long-acting insulin depot to fall back on, or during an acute illness. This is why ketones should be checked early when glucose is high or someone feels unwell.
What is the difference between DKA and HHS?
DKA features ketones and acidosis (low pH and bicarbonate) and is common in type 1 diabetes. Hyperosmolar hyperglycemic state (HHS) has much higher glucose — often over 600 mg/dL — with severe dehydration and high osmolality but little ketosis or acidosis, and is more typical of older adults with type 2 diabetes. Both are emergencies; HHS develops more slowly and carries a higher mortality.
Sources
- American Diabetes Association. Hyperglycemic crises in adult patients with diabetes (consensus statement).
- Kitabchi AE, et al. Management of hyperglycemic crises. Diabetes Care.
Last reviewed: June 2025