Abstract
Diabetic ketoacidosis (DKA) is a severe, acute, potentially fatal complication of diabetes mellitus, and this condition can range in severity from mild to severe. Severe DKA is distinguished by significant acid-base liability, hyperglycemia, high concentration of ketone bodies, and predisposition to complications, including neurological impairment, kidney failure, and systemic inflammatory reaction. This systematic review aimed to recognize and summarize clinical and laboratory findings between mild and severe DKA in pediatric and adult patients who presented to the emergency departments. The databases were searched extensively using PubMed, Web of Science, Cochrane Library, and Google Scholar to find original research articles that had been published between the years 2018 and 2025. The inclusion criteria were studies that provided clinical presentations, laboratory parameters, and outcomes based on DKA severity. Demographics and clinical presentations, biochemical markers, and complications of data were extracted. Seven articles that comprised 1,752 patients were reviewed. DKA was severe with decreased pH, bicarbonate, and base excess, increased anion gap, and serum beta-hydroxybutyrate and inflammatory markers (CRP, procalcitonin). Severe cases more frequently presented with altered consciousness, tachypnea, dyspnea, and severe dehydration. There was a higher neurological risk among pediatric patients and longer hospitalization and complications among type 2 diabetic adults. New markers like metabolomic patterns were associated with severity and can enhance risk stratification at early stages. Patients with severe DKA have divergent clinical and laboratory phenotypes as compared to their mild counterparts. The integration of conventional and new biomarkers could be useful to improve early detection and control.

Key words: Diabetic ketoacidosis, severity, mild DKA, severe DKA, clinical features, laboratory parameters, risk stratification, metabolic complications, systematic review