Diabetic Ketoacidosis Calculator

Diabetic ketoacidosis (DKA) is a serious acute complication of diabetes defined by the biochemical triad of hyperglycaemia (serum glucose >250 mg/dL), acidosis (arterial pH <7.3 and bicarbonate <18 mEq/L), and ketosis (presence of ketones in blood and/or urine). It results primarily from absolute or relative insulin deficiency and requires prompt medical management to reduce morbidity and mortality.

The American Diabetes Association (ADA) criteria for DKA include: serum glucose >250 mg/dL, arterial blood pH <7.3, serum bicarbonate <18 mEq/L, presence of serum and/or urine ketones, and an elevated anion gap (>12 mEq/L). All major criteria should be evaluated together for a complete assessment.

The anion gap is a calculated value reflecting unmeasured anions in the blood, normally 8–12 mEq/L. In DKA, the accumulation of ketoacids (beta-hydroxybutyrate and acetoacetate) increases the anion gap above 12 mEq/L, classifying it as a high anion gap metabolic acidosis. It is an important marker for confirming the presence of DKA and monitoring treatment response.

Common symptoms of DKA include excessive thirst (polydipsia), frequent urination (polyuria), nausea, vomiting, abdominal pain, fatigue, and fruity-smelling breath. In more severe cases, patients may exhibit Kussmaul breathing (rapid, deep breathing), altered mental status, drowsiness, or coma. Early recognition of these signs is critical for timely intervention.

Kussmaul breathing is a characteristic deep, labored, and rapid breathing pattern seen in DKA. It is the body's compensatory response to metabolic acidosis — by exhaling more CO2, the lungs attempt to raise the blood pH. It is named after Adolph Kussmaul, who first described it in 1874.

In DKA, the overproduction of ketoacids (beta-hydroxybutyrate and acetoacetate) consumes bicarbonate as the body attempts to buffer the acidosis. This leads to a fall in serum bicarbonate levels. The degree of bicarbonate reduction correlates with the severity of DKA: mild (15–18 mEq/L), moderate (10–14 mEq/L), and severe (<10 mEq/L).

Yes. Starvation ketoacidosis and alcoholic ketoacidosis can occur in non-diabetic individuals. Starvation ketoacidosis develops after prolonged fasting, while alcoholic ketoacidosis is triggered by heavy alcohol use with poor nutritional intake. Additionally, euglycemic DKA — a form of DKA with normal or near-normal blood glucose — can occur in diabetic patients using SGLT-2 inhibitors, during pregnancy, or after insulin administration.

Euglycemic DKA is a variant where ketoacidosis is present but blood glucose remains below 250 mg/dL. It can be triggered by SGLT-2 inhibitor use, reduced carbohydrate intake, pregnancy, or partial insulin administration. It is harder to diagnose because the hallmark hyperglycaemia is absent, making awareness of ketone levels and acid-base status especially important.