Box 4.

Markers of severity in diabetic ketoacidosis

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-)]