Diabetic Ketoacidosis (DKA) Calculator
Assess diabetic ketoacidosis using ADA diagnostic criteria with blood glucose, pH, bicarbonate, anion gap, and ketones. Get DKA severity and Efstathiou mortality risk score.
About This Calculator
The Diabetic Ketoacidosis (DKA) Calculator helps healthcare professionals and medical students assess DKA diagnostic criteria using the American Diabetes Association (ADA) guidelines. Enter patient blood glucose, arterial pH, serum bicarbonate, electrolytes, ketone status, and mental status to determine if the patient meets the criteria for diabetic ketoacidosis and classify the severity.
DKA is diagnosed when all five ADA criteria are met: blood glucose > 250 mg/dL, serum bicarbonate < 18 mEq/L, arterial pH < 7.3, elevated serum ketones, and anion gap > 12 mEq/L. The calculator computes the anion gap as Na⁺ − (Cl⁻ + HCO₃⁻), corrected sodium for hyperglycemia, and serum osmolality as 2 × Na⁺ + glucose/18. Severity is classified as mild, moderate, or severe based on pH, bicarbonate level, and mental status per the ADA consensus guidelines.
This tool also includes the Efstathiou mortality prediction model, a validated clinical scoring system that estimates in-hospital mortality risk based on five factors: age > 55 years, coma/stupor on admission, hypotension (SBP < 100 mmHg), arterial pH < 7.0, and serum osmolality > 350 mOsm/kg. Each factor scores one point; the total predicts mortality from < 1% (score 0-1) to ~70% (score 5).
Clinical notes: The anion gap formula used is the standard AG = Na − (Cl + HCO₃) with a normal reference range of 7-13 mEq/L. Corrected sodium = measured Na + 0.016(glucose − 100). Serum osmolality = 2(Na + K) + glucose/18 + BUN/2.8; this calculator uses the simplified 2 × Na + glucose/18 formula. DKA has a case fatality rate of 1-5% overall, with higher mortality in elderly patients and those with comorbidities. Cerebral edema is the most severe complication, occurring in 0.5-1% of DKA cases, predominantly in children.
Regional notes: DKA diagnostic criteria and management guidelines from the ADA are followed internationally including in India (RSSDI/API guidelines), the United States (ADA Standards of Care), and the United Kingdom (Joint British Diabetes Societies guidelines). Laboratory values use conventional units (mg/dL, mEq/L) consistent with clinical practice across all regions. For SI units: glucose mmol/L = mg/dL ÷ 18.02; bicarbonate and electrolytes in mmol/L are numerically identical to mEq/L.
Frequently Asked Questions
What is diabetic ketoacidosis (DKA)?
Diabetic ketoacidosis (DKA) is an acute, life-threatening complication of diabetes, primarily type 1 diabetes, characterized by hyperglycemia (blood glucose > 250 mg/dL), metabolic acidosis (pH < 7.3, bicarbonate < 18 mEq/L), and ketosis (elevated serum ketones). It results from insulin deficiency, causing the body to break down fats instead of glucose for energy, producing acidic ketones.
What are the ADA diagnostic criteria for DKA?
The American Diabetes Association (ADA) diagnostic criteria for DKA are: (1) blood glucose level over 250 mg/dL (13.8 mmol/L), (2) serum bicarbonate level less than 18 mEq/L, (3) arterial pH less than 7.3, (4) elevated serum ketone level, and (5) anion gap greater than 12 mEq/L. A patient must meet all criteria to be diagnosed with DKA.
How is DKA severity classified?
DKA severity is classified into three levels based on pH, bicarbonate, anion gap, and mental status: Mild DKA (pH 7.25-7.30, bicarbonate 15-18 mEq/L, anion gap > 10, alert), Moderate DKA (pH 7.00-7.24, bicarbonate 10 to < 15 mEq/L, anion gap > 12, alert/drowsy), and Severe DKA (pH < 7.00, bicarbonate < 10 mEq/L, anion gap > 12, stupor/coma). Mortality risk increases with severity.
What is the Efstathiou mortality score for DKA?
The Efstathiou mortality prediction model assigns one point each for five risk factors: age > 55 years, coma on admission, hypotension (systolic BP < 100 mmHg), arterial pH < 7.0, and serum osmolality > 350 mOsm/kg. Score 0-1 indicates low risk (< 1% mortality), score 2 indicates moderate risk (~12%), score 3 indicates high risk (~20-25%), and score 4-5 indicates very high risk (~40-70%).
What are the symptoms of diabetic ketoacidosis?
Common DKA symptoms include excessive thirst (polydipsia), frequent urination (polyuria), weight loss, fatigue, deep and rapid breathing (Kussmaul respirations), fruity-smelling breath (acetone odor), nausea and vomiting, abdominal pain, and confusion. In severe cases, DKA can progress to stupor, coma, and death without prompt medical treatment.
What causes diabetic ketoacidosis?
DKA is most commonly triggered by insulin deficiency from new-onset type 1 diabetes, missed insulin doses, insulin pump failure, infections (pneumonia, UTI), and physiological stressors (myocardial infarction, stroke, pancreatitis). Other causes include certain drugs (corticosteroids, antipsychotics, cocaine, SGLT-2 inhibitors) and alcohol abuse.
How is the anion gap calculated in DKA?
The anion gap is calculated using the formula: AG = Na⁺ − (Cl⁻ + HCO₃⁻). A normal anion gap is 7-13 mEq/L. In DKA, the anion gap is typically elevated (> 12 mEq/L) due to the accumulation of ketone bodies (acetoacetate and β-hydroxybutyrate) and lactic acid. The anion gap is essential for monitoring treatment response.
Can non-diabetics develop ketoacidosis?
Yes, though rare, non-diabetics can develop ketoacidosis. Alcoholic ketoacidosis occurs in chronic alcohol users after heavy drinking with poor food intake. Starvation ketosis and ketoacidosis from very low-carbohydrate diets have also been reported. Euglycemic DKA, where blood glucose is normal despite acidosis and ketosis, can occur with SGLT-2 inhibitor use in diabetic patients.