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==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):<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"
! 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;" + |PURPOSE
! 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 DKA
|-
| rowspan="4" |[[Arterial blood gas]]
|
* [[Blood]] [[pH]]
| rowspan="4" |
* Evaluation of [[Acid-base balance|acid-base status]] of the body
|
* 7.35-7.45
|
* <7.3
|-
|
* [[Serum]] [[bicarbonate]]
|
* 22-26 mEq/L
|
* <18 mEq/L
|-
|
* [[Arterial]] [[Carbon dioxide|CO2]]
|
* 35-45 mmHg
|
* Decreased secondary to [[hyperventilation]] as a compensation to [[metabolic acidosis]]
|-
|
* [[Arterial]] [[Oxygen|O2]]
|
* 75-100 mmHg
|
* 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" |
* Na– (Cl + HCO3)
| colspan="1" rowspan="1" |
* Evaluation of [[Acid base physiology|acid base disorders]]
| colspan="1" rowspan="1" |
* 7 to 13 mEq/L (7 to 13 mmol/L)
|
* Increased (>10 mEq/L required for diagnosis)
|-
| colspan="1" rowspan="1" |Osmolar gap
| colspan="1" rowspan="1" |
* [[Osmolality]] (measured) – [[osmolality]] (calculated)
| colspan="1" rowspan="1" |
* Difference between measured [[osmolality]] and calculated [[osmolality]]
| colspan="1" rowspan="1" |
* < 10 mmol/L
|
* Increased
|-
| colspan="1" rowspan="1" |[[Osmolality|Serum osmolality]]
| colspan="1" rowspan="1" |
* 2([[Sodium|Na]] + [[Potassium|K]]) + ([[glucose]]/18) + ([[blood]] [[urea]] [[nitrogen]]/2.8)
| colspan="1" rowspan="1" |
* Measure of particles in a [[fluid]] compartment
| colspan="1" rowspan="1" |
* 285 to 295 mOsm/kg (285 to 295 mmol/kg) of water
|
* Increased
|-
| colspan="1" rowspan="1" |[[Serum]] [[sodium]] correction
| colspan="1" rowspan="1" |
* Na + 0.016(glucose – 100)
| colspan="1" rowspan="1" |
* [[Hyperglycemia]] causes [[pseudohyponatremia]]
| colspan="1" rowspan="1" |
* 135 to 140 mEq per L (135 to 140 mmol per L)
|
* 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==
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[[Category:Endocrinology]]
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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
  • 7.35-7.45
  • <7.3
  • 22-26 mEq/L
  • <18 mEq/L
  • 35-45 mmHg
  • 75-100 mmHg
Anion gap
  • Na– (Cl + HCO3)
  • 7 to 13 mEq/L (7 to 13 mmol/L)
  • Increased (>10 mEq/L required for diagnosis)
Osmolar gap
  • < 10 mmol/L
  • Increased
Serum osmolality
  • Measure of particles in a fluid compartment
  • 285 to 295 mOsm/kg (285 to 295 mmol/kg) of water
  • Increased
Serum sodium correction
  • Na + 0.016(glucose – 100)
  • 135 to 140 mEq per L (135 to 140 mmol per L)
  • N/A
Blood urea nitrogen, creatinine levels
  • N/A
  • 7-20 mg/dl
  • 0.8-1.2mg/dl
Complete blood count (with differential)
  • N/A
  • Increased

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

  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:13607 Check |doi= value (help). PMID 10970986.
  8. ↑ 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.

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