Diabetic Ketoacidosis Calculator (DKA criteria and severity, 2024 consensus)

Understanding the diabetic ketoacidosis calculator — concept and principle

This calculator checks laboratory values against the 2024 international consensus criteria for diabetic ketoacidosis (DKA): D for diabetes or high glucose, K for ketones and A for acidosis. It shows whether each criterion is met, whether all three are present and, if so, the severity. Clinicians, nurses and students use it to apply the criteria consistently.

How it is calculated

• D: glucose 200 mg/dL (11.1 mmol/L) or more, or known diabetes
• K: blood beta-hydroxybutyrate 3.0 mmol/L or more, or urine ketones 2+ or more
• A: pH below 7.3 and/or bicarbonate below 18 mmol/L
• DKA = D, K and A all met
• Mild: pH above 7.25, bicarbonate 15 or more, ketones up to 6, alert
• Moderate: pH 7.0–7.25 or bicarbonate 10 to under 15, possibly drowsy
• Severe: pH below 7.0, bicarbonate below 10, ketones above 6 or stupor/coma
• The page uses the most severe feature present

The principle

Without enough insulin, the body cannot use glucose and breaks down fat, producing ketone acids faster than they can be cleared. The acids lower blood pH and use up bicarbonate. The 2024 consensus from ADA, EASD, JBDS, AACE and DTS dropped the old high glucose threshold for people with known diabetes, because DKA can occur with normal glucose, for example with SGLT2 inhibitors.

Worked example

Defaults: glucose 420 mg/dL, known diabetes, beta-hydroxybutyrate 4.5 mmol/L, urine not tested, pH 7.18, bicarbonate 12, alert.

1. D: 420 ≥ 200 → Met.
2. K: 4.5 ≥ 3.0 → Met.
3. A: pH 7.18 < 7.3 → Met.
4. All three: Yes.
5. pH 7.18 and bicarbonate 12 fall in the moderate range: Moderate DKA.

How to read the result

Meeting the criteria supports the diagnosis; treatment follows hospital DKA protocols with fluids, insulin and electrolyte monitoring. Severity guides where care takes place. Results change quickly, so values are repeated.

Common mistakes

• Ruling out DKA because glucose is normal.
• Relying on urine ketones when blood ketones are available.
• Using an old blood gas after treatment has started.
• Missing other causes of acidosis.

Frequently asked questions

Can DKA happen with normal blood sugar?

Yes, called euglycaemic DKA, for example with SGLT2 inhibitors.

What ketone level is needed for DKA?

Blood beta-hydroxybutyrate 3.0 mmol/L or more, or urine ketones 2+ or more.

What makes DKA severe?

pH below 7.0, bicarbonate below 10, ketones above 6 or stupor or coma.

Sources: Umpierrez GE, Davis GM, ElSayed NA, et al., "Hyperglycemic Crises in Adults With Diabetes: A Consensus Report", Diabetes Care 2024 (ADA/EASD/JBDS/AACE/DTS)