Hyperosmolar hyperglycemic state laboratory findings: Difference between revisions

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{{Hyperosmolar hyperglycemic state}}
{{Hyperosmolar hyperglycemic state}}


{{CMG}}; {{AE}}  
{{CMG}}; {{AE}} {{HS}}


==Overview==
==Overview==
An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].
Laboratory findings consistent with the diagnosis of hyperosmolar hyperglycemic state (HHS) include [[plasma glucose]] > 600 mg/dl, [[serum]] [[osmolarity]] > 320 mOsm/kg, [[blood]] [[pH]] > 7.3, [[serum]] [[bicarbonate]] > 18 mEq/L and negative or trace positive urine or serum [[ketones]].
 
OR
 
Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].
 
OR
 
[Test] is usually normal among patients with [disease name].
 
OR
 
Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].
 
OR
 
There are no diagnostic laboratory findings associated with [disease name].


==Laboratory Findings==
==Laboratory Findings==
The following lab abnormalities may be found in hyperosmolar hyperglycemic state (HHS):<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>
The following lab abnormalities may be found in hyperosmolar hyperglycemic state (HHS):<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=10.1159/000013607|url=}}</ref>
{| class="wikitable"
{| class="wikitable"
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" + |LAB
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" + |LAB
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" + | FORMULA/ VARIABLE
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" + |FORMULA/ VARIABLE
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" + |NORMAL VALUE
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" + |NORMAL VALUE
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" + |VALUE IN HHS
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" + |VALUE IN HHS
|-
|-
|[[Plasma glucose]] (mg/dL)
| align="center" style="background:#DCDCDC;" + |[[Plasma glucose]] (mg/dL)
|
|
* N/A
* Direct measurement
|
|
* < 200 mg/dl
* < 200 mg/dl
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* > 600 mg/dl
* > 600 mg/dl
|-
|-
|[[Arterial ph]]
| align="center" style="background:#DCDCDC;" + |Arterial pH
|
|
* [[Blood]] [[pH]]
* [[Blood]] [[pH]]
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* > 7.30
* > 7.30
|-
|-
| colspan="1" rowspan="1" |[[Anion gap]]
| colspan="1" rowspan="1" align="center" style="background:#DCDCDC;" + |[[Anion gap]]
| colspan="1" rowspan="1" |
| colspan="1" rowspan="1" |
* (Na+) – (Cl– + HCO3–)  
* (Na<sup>+</sup>) – (Cl<sup>–</sup> + HCO3<sup>–</sup>)  
| colspan="1" rowspan="1" |
| colspan="1" rowspan="1" |
* 7 to 13 (mEq/L)  
* 7 to 13 (mEq/L)  
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* Variable  
* Variable  
|-
|-
| colspan="1" rowspan="1" |[[Osmolality|Serum osmolality]]
| colspan="1" rowspan="1" align="center" style="background:#DCDCDC;" + |[[Osmolality|Serum osmolality]]
| colspan="1" rowspan="1" |
| colspan="1" rowspan="1" |
* 2([[Sodium|Na]] + [[Potassium|K]]) + ([[glucose]]/18) + ([[blood]] [[urea]] [[nitrogen]]/2.8)
* 2([[Sodium|Na]] + [[Potassium|K]]) + ([[glucose]]/18) + ([[blood]] [[urea]] [[nitrogen]]/2.8)
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* Increased (> 320mOsm/kg)
* Increased (> 320mOsm/kg)
|-
|-
|[[Plasma ketones]]
| align="center" style="background:#DCDCDC;" + |Plasma [[ketones]]
|
|
* Direct measurement
|
|
* Negative
|
|
* Trace or negative
* Trace or negative
|-
|-
|[[Urine ketones]]
| align="center" style="background:#DCDCDC;" + |Urine [[ketones]]
|
|
* Direct measurement
|
|
* Negative
|
|
* Trace or negative
* Trace or negative
|-
|-
|[[Serum Bicarbonate]]
| align="center" style="background:#DCDCDC;" + |[[Serum bicarbonate]]
|
|
* Direct measurement
|
|
* 23 - 29 mEq/L
* 23 - 29 mEq/L
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* > 18 mEq/L
* > 18 mEq/L
|-
|-
|[[Blood urea nitrogen]], [[creatinine]] levels
| align="center" style="background:#DCDCDC;" + |[[Blood urea nitrogen]] ([[BUN]]), [[creatinine]] levels
|
|
* N/A
* N/A
|
|
* 7-20 mg/dl
* [[BUN]]: 7-20 mg/dl
* 0.8-1.2mg/dl
* [[Creatinine]] levels: 0.8-1.2mg/dl
|
|
* Increased ([[Dehydration]] and decreased [[renal]] [[perfusion]])
* Increased ([[Dehydration]] and decreased [[renal]] [[perfusion]])
|-
|[[Complete blood count]] (with differential)
|
* N/A
|
|
* Increased
|}
|}


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{{WH}}
{{WH}}
{{WS}}
{{WS}}
[[Category:Medicine]]
[[Category:Endocrinology]]
[[Category:Up-To-Date]]
​
[[Category:Emergency medicine]]

Latest revision as of 18:19, 23 October 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Husnain Shaukat, M.D [2]

Overview

Laboratory findings consistent with the diagnosis of hyperosmolar hyperglycemic state (HHS) include plasma glucose > 600 mg/dl, serum osmolarity > 320 mOsm/kg, blood pH > 7.3, serum bicarbonate > 18 mEq/L and negative or trace positive urine or serum ketones.

Laboratory Findings

The following lab abnormalities may be found in hyperosmolar hyperglycemic state (HHS):[1][2][3][4][5][6][7]

LAB FORMULA/ VARIABLE NORMAL VALUE VALUE IN HHS
Plasma glucose (mg/dL)
  • Direct measurement
  • < 200 mg/dl
  • > 600 mg/dl
Arterial pH
  • 7.35-7.45
  • > 7.30
Anion gap
  • (Na+) – (Cl– + HCO3–)
  • 7 to 13 (mEq/L)
  • Variable
Serum osmolality
  • 285 to 295 mOsm/kg (285 to 295 mmol/kg) of water
  • Increased (> 320mOsm/kg)
Plasma ketones
  • Direct measurement
  • Negative
  • Trace or negative
Urine ketones
  • Direct measurement
  • Negative
  • Trace or negative
Serum bicarbonate
  • Direct measurement
  • 23 - 29 mEq/L
  • > 18 mEq/L
Blood urea nitrogen (BUN), creatinine levels
  • N/A

References

  1. ↑ 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.
  2. ↑ 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.
  3. ↑ 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.
  4. ↑ 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.
  5. ↑ 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.
  6. ↑ Molitch ME, Rodman E, Hirsch CA, Dubinsky E (1980). "Spurious serum creatinine elevations in ketoacidosis". Ann. Intern. Med. 93 (2): 280–1. PMID 6773457.
  7. ↑ 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:10.1159/000013607. PMID 10970986.

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