Diabetic ketoacidosis laboratory findings: Difference between revisions
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{{Diabetic ketoacidosis}} | {{Diabetic ketoacidosis}} | ||
{{CMG}} | {{CMG}} | ||
==Overview== | ==Overview== | ||
Laboratory findings consistent with the diagnosis of diabetic ketoacidosis (DKA) include [[blood]] [[pH]] < 7.3, [[serum]] [[bicarbonate]] < 18 mEq/L, [[anion gap]] > 10 mEq/L and increased [[serum]] [[osmolarity]]. | |||
== Laboratory Findings == | == Laboratory Findings == | ||
The following lab abnormalities may be found in diabetic ketoacidosis (DKA):<ref name="pmid19564476">{{cite journal |vauthors=Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN |title=Hyperglycemic crises in adult patients with diabetes |journal=Diabetes Care |volume=32 |issue=7 |pages=1335–43 |year=2009 |pmid=19564476 |pmc=2699725 |doi=10.2337/dc09-9032 |url=}}</ref><ref name="pmid12668546">{{cite journal |vauthors=Chiasson JL, Aris-Jilwan N, Bélanger R, Bertrand S, Beauregard H, Ekoé JM, Fournier H, Havrankova J |title=Diagnosis and treatment of diabetic ketoacidosis and the hyperglycemic hyperosmolar state |journal=CMAJ |volume=168 |issue=7 |pages=859–66 |year=2003 |pmid=12668546 |pmc=151994 |doi= |url=}}</ref><ref name="pmid25325058">{{cite journal |vauthors=Liamis G, Liberopoulos E, Barkas F, Elisaf M |title=Diabetes mellitus and electrolyte disorders |journal=World J Clin Cases |volume=2 |issue=10 |pages=488–96 |year=2014 |pmid=25325058 |pmc=4198400 |doi=10.12998/wjcc.v2.i10.488 |url=}}</ref><ref name="pmid3084904">{{cite journal |vauthors=Adrogué HJ, Lederer ED, Suki WN, Eknoyan G |title=Determinants of plasma potassium levels in diabetic ketoacidosis |journal=Medicine (Baltimore) |volume=65 |issue=3 |pages=163–72 |year=1986 |pmid=3084904 |doi= |url=}}</ref><ref name="pmid23630441">{{cite journal |vauthors=Xu W, Wu HF, Ma SG, Bai F, Hu W, Jin Y, Liu H |title=Correlation between peripheral white blood cell counts and hyperglycemic emergencies |journal=Int J Med Sci |volume=10 |issue=6 |pages=758–65 |year=2013 |pmid=23630441 |pmc=3638300 |doi=10.7150/ijms.6155 |url=}}</ref><ref name="pmid6773457">{{cite journal |vauthors=Molitch ME, Rodman E, Hirsch CA, Dubinsky E |title=Spurious serum creatinine elevations in ketoacidosis |journal=Ann. Intern. Med. |volume=93 |issue=2 |pages=280–1 |year=1980 |pmid=6773457 |doi= |url=}}</ref><ref name="pmid10970986">{{cite journal |vauthors=Gokel Y, Paydas S, Koseoglu Z, Alparslan N, Seydaoglu G |title=Comparison of blood gas and acid-base measurements in arterial and venous blood samples in patients with uremic acidosis and diabetic ketoacidosis in the emergency room |journal=Am. J. Nephrol. |volume=20 |issue=4 |pages=319–23 |year=2000 |pmid=10970986 |doi=13607 |url=}}</ref> | |||
{| class="wikitable" | {| class="wikitable" | ||
! colspan="1" rowspan="1" |LAB | ! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" + |LAB | ||
! colspan="1" rowspan="1" |FORMULA/ VARIABLE | ! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" + | FORMULA/ VARIABLE | ||
! colspan="1" rowspan="1" |PURPOSE | ! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" + |PURPOSE | ||
! colspan="1" rowspan="1" |NORMAL VALUE | ! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" + |NORMAL VALUE | ||
!VALUE IN DKA | ! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" + |VALUE IN DKA | ||
|- | |- | ||
| rowspan="4" |Arterial blood gas | | rowspan="4" |[[Arterial blood gas]] | ||
| | | | ||
* Blood pH | * [[Blood]] [[pH]] | ||
| rowspan="4" | | | rowspan="4" | | ||
* Evaluation of acid-base status of the body | * Evaluation of [[Acid-base balance|acid-base status]] of the body | ||
| | | | ||
* 7.35-7.45 | * 7.35-7.45 | ||
| Line 27: | Line 26: | ||
|- | |- | ||
| | | | ||
* Serum bicarbonate | * [[Serum]] [[bicarbonate]] | ||
| | | | ||
* 22-26 mEq/L | * 22-26 mEq/L | ||
| Line 34: | Line 33: | ||
|- | |- | ||
| | | | ||
* Arterial CO2 | * [[Arterial]] [[Carbon dioxide|CO2]] | ||
| | | | ||
* 35-45 mmHg | * 35-45 mmHg | ||
| | | | ||
* Decreased secondary to hyperventilation as a compensation to metabolic acidosis | * Decreased secondary to [[hyperventilation]] as a compensation to [[metabolic acidosis]] | ||
|- | |- | ||
| | | | ||
* Arterial O2 | * [[Arterial]] [[Oxygen|O2]] | ||
| | | | ||
* 75-100 mmHg | * 75-100 mmHg | ||
| | | | ||
* Within normal range unless there is concomitant respiratory infection e.g. pneumonia leading to hypoxia) | * Within normal range unless there is concomitant [[Respiratory tract infection|respiratory infection]] e.g. [[pneumonia]] leading to [[hypoxia]]) | ||
|- | |- | ||
| colspan="1" rowspan="1" |Anion gap | | colspan="1" rowspan="1" |[[Anion gap]] | ||
| colspan="1" rowspan="1" | | | colspan="1" rowspan="1" | | ||
* Na– (Cl + HCO3) | * Na– (Cl + HCO3) | ||
| colspan="1" rowspan="1" | | | colspan="1" rowspan="1" | | ||
* Evaluation of acid base disorders | * Evaluation of [[Acid base physiology|acid base disorders]] | ||
| colspan="1" rowspan="1" | | | colspan="1" rowspan="1" | | ||
* 7 to 13 mEq/L (7 to 13 mmol/L) | * 7 to 13 mEq/L (7 to 13 mmol/L) | ||
| | | | ||
* Increased | * Increased (>10 mEq/L required for diagnosis) | ||
|- | |- | ||
| colspan="1" rowspan="1" |Osmolar gap | | colspan="1" rowspan="1" |Osmolar gap | ||
| colspan="1" rowspan="1" | | | colspan="1" rowspan="1" | | ||
* Osmolality (measured) – osmolality (calculated) | * [[Osmolality]] (measured) – [[osmolality]] (calculated) | ||
| colspan="1" rowspan="1" | | | colspan="1" rowspan="1" | | ||
* Difference between measured osmolality and calculated osmolality | * Difference between measured [[osmolality]] and calculated [[osmolality]] | ||
| colspan="1" rowspan="1" | | | colspan="1" rowspan="1" | | ||
* < 10 mmol/L | * < 10 mmol/L | ||
| Line 67: | Line 66: | ||
* Increased | * Increased | ||
|- | |- | ||
| colspan="1" rowspan="1" |Serum osmolality | | colspan="1" rowspan="1" |[[Osmolality|Serum osmolality]] | ||
| colspan="1" rowspan="1" | | | colspan="1" rowspan="1" | | ||
* 2(Na + K) + (glucose/18) + (blood urea nitrogen/2.8) | * 2([[Sodium|Na]] + [[Potassium|K]]) + ([[glucose]]/18) + ([[blood]] [[urea]] [[nitrogen]]/2.8) | ||
| colspan="1" rowspan="1" | | | colspan="1" rowspan="1" | | ||
* Measure of particles in a fluid compartment | * Measure of particles in a [[fluid]] compartment | ||
| colspan="1" rowspan="1" | | | colspan="1" rowspan="1" | | ||
* 285 to 295 mOsm/kg (285 to 295 mmol/kg) of water | * 285 to 295 mOsm/kg (285 to 295 mmol/kg) of water | ||
| Line 77: | Line 76: | ||
* Increased | * Increased | ||
|- | |- | ||
| colspan="1" rowspan="1" |Serum sodium correction | | colspan="1" rowspan="1" |[[Serum]] [[sodium]] correction | ||
| colspan="1" rowspan="1" | | | colspan="1" rowspan="1" | | ||
* Na + 0.016(glucose – 100) | * Na + 0.016(glucose – 100) | ||
| colspan="1" rowspan="1" | | | colspan="1" rowspan="1" | | ||
* Hyperglycemia causes pseudohyponatremia | * [[Hyperglycemia]] causes [[pseudohyponatremia]] | ||
| colspan="1" rowspan="1" | | | colspan="1" rowspan="1" | | ||
* 135 to 140 mEq per L (135 to 140 mmol per L) | * 135 to 140 mEq per L (135 to 140 mmol per L) | ||
| Line 87: | Line 86: | ||
* N/A | * N/A | ||
|- | |- | ||
|[[Blood urea nitrogen]], [[creatinine]] levels | |||
| | |||
* N/A | |||
| | |||
* To assess [[renal function]] | |||
| | | | ||
* 7-20 mg/dl | |||
* 0.8-1.2mg/dl | |||
| | | | ||
* Increased ([[Dehydration]] and decreased [[renal]] [[perfusion]]) | |||
|- | |||
|[[Complete blood count]] (with differential) | |||
| | | | ||
* N/A | |||
| | | | ||
* Assess [[infection]] | |||
* To rule out [[pancreatitis]] | |||
| | | | ||
| | |||
* Increased | |||
|} | |} | ||
=== | === Deficits in diabetic ketoacidosis === | ||
The following deficits may be seen in mild DKA:<ref name="pmid11194218">{{cite journal |vauthors=Kitabchi AE, Umpierrez GE, Murphy MB, Barrett EJ, Kreisberg RA, Malone JI, Wall BM |title=Management of hyperglycemic crises in patients with diabetes |journal=Diabetes Care |volume=24 |issue=1 |pages=131–53 |year=2001 |pmid=11194218 |doi= |url=}}</ref> | |||
* Total water (L): 6 | |||
* Water (mL/kg): 100 | |||
| | * Na+ (mEq/kg): 7 to 10 | ||
* Cl- (mEq/kg): 3 to 5 | |||
* K+ (mEq/kg): 3 to 5 | |||
| | * PO4 (mmol/kg): 5 to 7 | ||
| | * Mg++ (mEq/kg): 1 to 2 | ||
* Ca++ (mEq/kg): 1 to 2 | |||
| | |||
| | |||
| | |||
==References== | ==References== | ||
Latest revision as of 20:27, 23 August 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Laboratory findings consistent with the diagnosis of diabetic ketoacidosis (DKA) include blood pH < 7.3, serum bicarbonate < 18 mEq/L, anion gap > 10 mEq/L and increased serum osmolarity.
Laboratory Findings
The following lab abnormalities may be found in diabetic ketoacidosis (DKA):[1][2][3][4][5][6][7]
| LAB | FORMULA/ VARIABLE | PURPOSE | NORMAL VALUE | VALUE IN DKA |
|---|---|---|---|---|
| Arterial blood gas |
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| Anion gap |
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| Osmolar gap |
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| Serum osmolality |
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| Serum sodium correction |
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| Blood urea nitrogen, creatinine levels |
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| Complete blood count (with differential) |
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Deficits in diabetic ketoacidosis
The following deficits may be seen in mild DKA:[8]
- Total water (L): 6
- Water (mL/kg): 100
- Na+ (mEq/kg): 7 to 10
- Cl- (mEq/kg): 3 to 5
- K+ (mEq/kg): 3 to 5
- PO4 (mmol/kg): 5 to 7
- Mg++ (mEq/kg): 1 to 2
- Ca++ (mEq/kg): 1 to 2
References
- ↑ Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN (2009). "Hyperglycemic crises in adult patients with diabetes". Diabetes Care. 32 (7): 1335–43. doi:10.2337/dc09-9032. PMC 2699725. PMID 19564476.
- ↑ Chiasson JL, Aris-Jilwan N, Bélanger R, Bertrand S, Beauregard H, Ekoé JM, Fournier H, Havrankova J (2003). "Diagnosis and treatment of diabetic ketoacidosis and the hyperglycemic hyperosmolar state". CMAJ. 168 (7): 859–66. PMC 151994. PMID 12668546.
- ↑ Liamis G, Liberopoulos E, Barkas F, Elisaf M (2014). "Diabetes mellitus and electrolyte disorders". World J Clin Cases. 2 (10): 488–96. doi:10.12998/wjcc.v2.i10.488. PMC 4198400. PMID 25325058.
- ↑ Adrogué HJ, Lederer ED, Suki WN, Eknoyan G (1986). "Determinants of plasma potassium levels in diabetic ketoacidosis". Medicine (Baltimore). 65 (3): 163–72. PMID 3084904.
- ↑ Xu W, Wu HF, Ma SG, Bai F, Hu W, Jin Y, Liu H (2013). "Correlation between peripheral white blood cell counts and hyperglycemic emergencies". Int J Med Sci. 10 (6): 758–65. doi:10.7150/ijms.6155. PMC 3638300. PMID 23630441.
- ↑ Molitch ME, Rodman E, Hirsch CA, Dubinsky E (1980). "Spurious serum creatinine elevations in ketoacidosis". Ann. Intern. Med. 93 (2): 280–1. PMID 6773457.
- ↑ Gokel Y, Paydas S, Koseoglu Z, Alparslan N, Seydaoglu G (2000). "Comparison of blood gas and acid-base measurements in arterial and venous blood samples in patients with uremic acidosis and diabetic ketoacidosis in the emergency room". Am. J. Nephrol. 20 (4): 319–23. doi:13607 Check
|doi=value (help). PMID 10970986. - ↑ Kitabchi AE, Umpierrez GE, Murphy MB, Barrett EJ, Kreisberg RA, Malone JI, Wall BM (2001). "Management of hyperglycemic crises in patients with diabetes". Diabetes Care. 24 (1): 131–53. PMID 11194218.