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 == | ||
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!VALUE IN DKA | !VALUE IN DKA | ||
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| rowspan="4" |Arterial blood gas | | rowspan="4" |[[Arterial blood gas]] | ||
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* 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 | ||
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* 7.35-7.45 | * 7.35-7.45 | ||
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* Serum bicarbonate | * [[Serum]] [[bicarbonate]] | ||
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* 22-26 mEq/L | * 22-26 mEq/L | ||
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* Arterial CO2 | * [[Arterial]] [[Carbon dioxide|CO2]] | ||
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* 35-45 mmHg | * 35-45 mmHg | ||
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* Arterial O2 | * [[Arterial]] [[Oxygen|O2]] | ||
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* 75-100 mmHg | * 75-100 mmHg | ||
| Line 47: | Line 46: | ||
* Within normal range unless there is concomitant respiratory infection e.g. pneumonia leading to hypoxia) | * Within normal range unless there is concomitant respiratory infection e.g. pneumonia leading to hypoxia) | ||
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| 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) | ||
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* Increased | * Increased | ||
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| 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(Na + K) + (glucose/18) + (blood urea nitrogen/2.8) | ||
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* Increased | * Increased | ||
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| 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) | ||
| Line 87: | Line 86: | ||
* N/A | * N/A | ||
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|Blood urea nitrogen, creatinine levels | |[[Blood urea nitrogen]], [[creatinine]] levels | ||
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* N/A | * N/A | ||
| Line 98: | Line 97: | ||
* Increased (Dehydration and decreased renal perfusion) | * Increased (Dehydration and decreased renal perfusion) | ||
|- | |- | ||
|Complete blood count (with differential) | |[[Complete blood count]] (with differential) | ||
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* N/A | * N/A | ||
Revision as of 19:44, 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 |
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| 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.