DKA & HSS

DKA & HHS is a free, evidence-based clinical reference app for the management of Diabetic Ketoacidosis and Hyperosmolar Hyperglycaemic State, based on the Joint British Diabetes Societies (JBDS) 2023 DKA and 2012 HHS guidelines.

Developed by Dr Atif Elnil MBBS MRCP, Neurology Department, St George's Hospital, London, designed for rapid bedside use by any clinician encountering these life-threatening diabetic emergencies.

*** WHAT IS COVERED ***

- DKA vs HHS comparison: 14-parameter side-by-side comparison table covering glucose, pH, ketones, osmolality, onset, fluid deficit, insulin approach, thrombotic risk, and mortality
- DKA severity classification: mild, moderate, and severe criteria per JBDS 2023 with management actions for each level
- HHS diagnostic criteria and severity grading with osmolality-based thresholds
- ECG changes: full sequence of hyperkalaemia changes in DKA from peaked T-waves to sine wave and cardiac arrest
- Step-by-step DKA fluid protocol: JBDS 2023 resuscitation through to resolution with hourly targets
- Insulin protocol: Fixed Rate IV Insulin Infusion (FRIII) with weight-based dose table, monitoring targets, and long-acting insulin guidance
- Potassium replacement guide: four K+ ranges with specific actions including when to withhold insulin
- HHS fluid protocol: osmolality-guided replacement over 48 hours with thromboprophylaxis guidance
- Resolution criteria: when and how to safely transition from IV to SC insulin for both DKA and HHS
- Common errors and pitfalls: nine dangerous mistakes that cause patient harm, with explanations

*** LIVE CALCULATORS ***

- Effective osmolality: HHS diagnosis and monitoring with clinical interpretation
- Corrected sodium in DKA: corrects for hyperglycaemia-induced pseudohyponatraemia
- Anion gap with albumin correction: confirms high anion gap metabolic acidosis
- Ketone clearance tracker: enter two consecutive ketone readings to check if treatment is on target

*** SPECIAL POPULATIONS ***

- Paediatric DKA: BSPED 2020 protocol with cerebral oedema recognition and emergency treatment (mannitol dose, fluid restriction)
- Pregnancy: obstetric emergency guidance, euglycaemic DKA recognition, foetal monitoring
- Elderly: HHS-predominant considerations, fluid overload risk, drug adjustments
- Renal failure: modified fluid approach, hyperkalaemia thresholds, dialysis indications
- Type 1 vs Type 2