The presence of one or more of the following may indicate severe diabetic ketoacidosis. Patient requires senior review with consideration of transfer to high-dependency unit.
Blood ketones over 6 mmol/L
Bicarbonate level below 5 mmol/L
Venous/arterial pH below 7.0
Hypokalaemia on admission (under 3.5 mmol/L)
Glasgow coma score less than 12 or abnormal alert, verbal, pain, unresponsive (AVPU) scale
Oxygen saturation below 92% on air (assuming normal baseline respiratory function)
Systolic blood pressure below 90 mmHg
Pulse over 100 or below 60 bpm
Anion gap above 16 [Anion gap = (Na+ + K+) - (Cl- + HCO3-)]