Diabetic ketoacidosis laboratory findings: Difference between revisions

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Revision as of 16:51, 4 August 2017

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Overview

Laboratory Findings

Serum glucose

The diagnosis of diabetic ketoacidosis is based on a serum glucose level of > 250mg/dl

Arterial blood gas (ABG)

Arterial blood gas widely recommended test for determining pH

Diagnostic Criteria for Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State

CRITERION	DIABETIC KETOACIDOSIS
CRITERION	MILD (SERUM GLUCOSE > 250 MG PER DL [13.88 MMOL PER L])	MODERATE (SERUM GLUCOSE > 250 MG PER DL)	SEVERE (SERUM GLUCOSE > 250 MG PER DL)
Anion gap*	> 10 mEq per L (10 mmol per L)	> 12 mEq per L (12 mmol per L)	> 12 mEq per L (12 mmol per L)
Arterial pH	7.24 to 7.30	7.00 to < 7.24	< 7.00
Effective serum osmolality*	Variable	Variable	Variable
Mental status	Alert	Alert/drowsy	Stupor/coma
Serum bicarbonate	15 to 18 mEq per L (15 to 18 mmol per L)	10 to < 15 mEq per L (10 to < 15 mmol per L)	< 10 mEq per L (10 mmol per L)
Serum ketone†	Positive	Positive	Positive
Urine ketone†	Positive	Positive	Positive

Calculations for the Evaluation of Diabetic Ketoacidosis

VALUE	PURPOSE	FORMULA	NORMAL VALUE
Anion gap	Essential for evaluation of acid base disorders	Na– (Cl + HCO3)	7 to 13 mEq per L (7 to 13 mmol per L)
Osmolar gap	Difference between measured osmolality and calculated osmolality	Osmolality (measured) – osmolality (calculated)	< 10 mmol per L*
Serum osmolality	Measure of particles in a fluid compartment	2(Na + K) + (glucose/18) + (blood urea nitrogen/2.8)	285 to 295 mOsm per kg (285 to 295 mmol per kg) of water
Serum sodium correction	Hyperglycemia causes pseudohyponatremia	Na + 0.016(glucose – 100)	135 to 140 mEq per L (135 to 140 mmol per L)

Suggested Laboratory Evaluation for Persons with Diabetic Ketoacidosis

TEST	COMMENTS
For all patients
A1C	To determine level of glycemic control in persons with diabetes mellitus
Anion gap (electrolytes)	Usually greater than 15 mEq per L (15 mmol per L)
Arterial blood gas measurement	Below 7.3
Arterial blood gas measurement	Arterial blood gas measurement is the most widely recommended test for determining pH, but measurement of venous blood gas has gained acceptance
Blood urea nitrogen, creatinine levels	Usually elevated because of dehydration and decreased renal perfusion
Complete blood count (with differential)	May be elevated in persons with DKA, but without pancreatitis
Complete blood count (with differential)	Diagnosis of pancreatitis should be based on clinical judgment and imaging
Electrocardiography	Assesses effect of potassium status; rules out ischemia or myocardial infarction
Serum bicarbonate level	Less than 18 mEq per L (18 mmol per L)

References

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@@ Line 8: / Line 8: @@
 == Laboratory Findings ==
-* {| class="wikitable" ! colspan="4" |Laboratory findings in type 1 diabetes based on presentation |- | | |Classic new onset |Diabetic Ketoacidosis |- | rowspan="12" |Blood |Glucose |
-* Random:  random (nonfasting) plasma glucose concentration of 200 mg/dL or higher
+=== Serum glucose ===
-* Fasting plasma glucose concentration of 126 mg/dL (6.99 mmol/L) or higher |Random glucose sugar is more then 250 mg/dl |- |HbA1c |HbA<sub>1c</sub> level of 6.5% or higher |Not applicable |- |CBC with differential |Normal |Mildly elevated with normal differential |- |Basic metabolic panel |Normal |Serum bicarbonate < 18 mEq/L Serum Sodium: Often normal or elevated  Serum Phosphate: Often normal or elevated  Serum Potassium: Often normal or elevated |- |Serum Creatinine |Normal |Often elevated |- |Serum calicum |Normal |Decreased |- |Serum amylase |Normal |Mildly elevated |- |Serum Lipase |Normal |Normal |- |Serum osmorality |Normal |Normal |- |Serum Ketones |Normal |High |- |Anion gap |normal |High |- |Arterial Blood gas |Normal |Metabolic acidosis, compensated by respiratory alkalosis |- | rowspan="2" |Urine |Glucose |May or may not be present(Blood glucose should be more then 200 mg/dl to appear in urine) |Often present |- |Ketones |absent |Present |} There are two different tests your doctor can use to determine whether you have pre-diabetes or diabetes: the fasting plasma glucose test (FPG) or the [[oral glucose tolerance test]] ([[OGTT]]). The blood glucose levels measured after these tests determine whether you have a normal metabolism, or whether you have pre-diabetes or diabetes. If your blood glucose level is abnormal following the FPG, you have impaired fasting glucose (IFG); if your blood glucose level is abnormal following the OGTT, you have impaired glucose tolerance (IGT).
+* The diagnosis of diabetic ketoacidosis is based on a serum glucose level of > 250mg/dl
-*
-*
+=== Arterial blood gas (ABG) ===
-*The patient with medical history of [[diabetes]], during an illness such as [[pneumonia]], [[heart attack]], [[stroke]] or [[pregnancy]] has a [[Blood sugar]] level  higher than 240 mg/dl.
+* Arterial blood gas widely recommended test for determining pH
-*Higer blood ketone level
-*Arterial blood gas: When diabetic ketoacidosis occurs, the blood will become acidic (acidosis). This can damage organs throughout the body.
+==== Diagnostic Criteria for Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State ====
-*Urinalysis：[[Sugar]] and [[ketone]] can be checked in urin of patients with diabetic ketoacidosis.*Additional tests, such as a chest x-ray or a [[electrocardiogram]], may be needed to help the doctor determine what triggered the episode of diabetic ketoacidosis or what damage the ketoacidosis may have caused.
+{| class="wikitable"
+! colspan="1" rowspan="2" |CRITERION
+! colspan="3" rowspan="1" |DIABETIC KETOACIDOSIS
+|-
+! colspan="1" rowspan="1" |MILD (SERUM GLUCOSE > 250 MG PER DL [13.88 MMOL PER L])
+! colspan="1" rowspan="1" |MODERATE (SERUM GLUCOSE > 250 MG PER DL)
+! colspan="1" rowspan="1" |SEVERE (SERUM GLUCOSE > 250 MG PER DL)
+|-
+| colspan="1" rowspan="1" |Anion gap*
+| colspan="1" rowspan="1" |> 10 mEq per L (10 mmol per L)
+| colspan="1" rowspan="1" |> 12 mEq per L (12 mmol per L)
+| colspan="1" rowspan="1" |> 12 mEq per L (12 mmol per L)
+|-
+| colspan="1" rowspan="1" |Arterial pH
+| colspan="1" rowspan="1" |7.24 to 7.30
+| colspan="1" rowspan="1" |7.00 to < 7.24
+| colspan="1" rowspan="1" |< 7.00
+|-
+| colspan="1" rowspan="1" |Effective serum osmolality*
+| colspan="1" rowspan="1" |Variable
+| colspan="1" rowspan="1" |Variable
+| colspan="1" rowspan="1" |Variable
+|-
+| colspan="1" rowspan="1" |Mental status
+| colspan="1" rowspan="1" |Alert
+| colspan="1" rowspan="1" |Alert/drowsy
+| colspan="1" rowspan="1" |Stupor/coma
+|-
+| colspan="1" rowspan="1" |Serum bicarbonate
+| colspan="1" rowspan="1" |15 to 18 mEq per L (15 to 18 mmol per L)
+| colspan="1" rowspan="1" |10 to < 15 mEq per L (10 to < 15 mmol per L)
+| colspan="1" rowspan="1" |< 10 mEq per L (10 mmol per L)
+|-
+| colspan="1" rowspan="1" |Serum ketone†
+| colspan="1" rowspan="1" |Positive
+| colspan="1" rowspan="1" |Positive
+| colspan="1" rowspan="1" |Positive
+|-
+| colspan="1" rowspan="1" |Urine ketone†
+| colspan="1" rowspan="1" |Positive
+| colspan="1" rowspan="1" |Positive
+| colspan="1" rowspan="1" |Positive
+|}
+==== Calculations for the Evaluation of Diabetic Ketoacidosis ====
+{| class="wikitable"
+! colspan="1" rowspan="1" |VALUE
+! colspan="1" rowspan="1" |PURPOSE
+! colspan="1" rowspan="1" |FORMULA
+! colspan="1" rowspan="1" |NORMAL VALUE
+|-
+| colspan="1" rowspan="1" |Anion gap
+| colspan="1" rowspan="1" |Essential for evaluation of acid base disorders
+| colspan="1" rowspan="1" |Na– (Cl + HCO3)
+| colspan="1" rowspan="1" |7 to 13 mEq per L (7 to 13 mmol per L)
+|-
+| colspan="1" rowspan="1" |Osmolar gap
+| colspan="1" rowspan="1" |Difference between measured osmolality and calculated osmolality
+| colspan="1" rowspan="1" |Osmolality (measured) – osmolality (calculated)
+| colspan="1" rowspan="1" |< 10 mmol per L*
+|-
+| colspan="1" rowspan="1" |Serum osmolality
+| colspan="1" rowspan="1" |Measure of particles in a fluid compartment
+| colspan="1" rowspan="1" |2(Na + K) + (glucose/18) + (blood urea nitrogen/2.8)
+| colspan="1" rowspan="1" |285 to 295 mOsm per kg (285 to 295 mmol per kg) of water
+|-
+| colspan="1" rowspan="1" |Serum sodium correction
+| colspan="1" rowspan="1" |Hyperglycemia causes pseudohyponatremia
+| colspan="1" rowspan="1" |Na + 0.016(glucose – 100)
+| colspan="1" rowspan="1" |135 to 140 mEq per L (135 to 140 mmol per L)
+|}
+==== Suggested Laboratory Evaluation for Persons with Diabetic Ketoacidosis ====
+{| class="wikitable"
+! colspan="1" rowspan="1" |TEST
+! colspan="1" rowspan="1" |COMMENTS
+|-
+| colspan="2" rowspan="1" |For all patients
+|-
+| colspan="1" rowspan="1" |A1C
+| colspan="1" rowspan="1" |To determine level of glycemic control in persons with diabetes mellitus
+|-
+| colspan="1" rowspan="1" |Anion gap (electrolytes)
+| colspan="1" rowspan="1" |Usually greater than 15 mEq per L (15 mmol per L)
+|-
+| colspan="1" rowspan="2" |Arterial blood gas measurement
+| colspan="1" rowspan="1" |Below 7.3
+|-
+| colspan="1" rowspan="1" |Arterial blood gas measurement is the most widely recommended test for determining pH, but measurement of venous blood gas has gained acceptance
+|-
+| colspan="1" rowspan="1" |Blood urea nitrogen, creatinine levels
+| colspan="1" rowspan="1" |Usually elevated because of dehydration and decreased renal perfusion
+|-
+| colspan="1" rowspan="2" |Complete blood count (with differential)
+| colspan="1" rowspan="1" |May be elevated in persons with DKA, but without pancreatitis
+|-
+| colspan="1" rowspan="1" |Diagnosis of pancreatitis should be based on clinical judgment and imaging
+|-
+| colspan="1" rowspan="1" |Electrocardiography
+| colspan="1" rowspan="1" |Assesses effect of potassium status; rules out ischemia or myocardial infarction
+|-
+| colspan="1" rowspan="1" |Serum bicarbonate level
+| colspan="1" rowspan="1" |Less than 18 mEq per L (18 mmol per L)
+|}
 ==References==

Diabetic ketoacidosis laboratory findings: Difference between revisions

Revision as of 16:51, 4 August 2017

Overview

Laboratory Findings

Serum glucose

Arterial blood gas (ABG)

Diagnostic Criteria for Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State

Calculations for the Evaluation of Diabetic Ketoacidosis

Suggested Laboratory Evaluation for Persons with Diabetic Ketoacidosis

References

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