Diabetic ketoacidosis laboratory findings: Difference between revisions

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== Laboratory Findings ==
== 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 ====
{| class="wikitable"
{| class="wikitable"
! colspan="1" rowspan="2" |CRITERION
! colspan="1" rowspan="1" |LAB
! colspan="3" rowspan="1" |DIABETIC KETOACIDOSIS
! colspan="1" rowspan="1" |FORMULA/ VARIABLE
|-
! colspan="1" rowspan="1" |PURPOSE
! colspan="1" rowspan="1" |MILD (SERUM GLUCOSE > 250 MG PER DL [13.88 MMOL PER L])
! colspan="1" rowspan="1" |NORMAL VALUE
! colspan="1" rowspan="1" |MODERATE (SERUM GLUCOSE > 250 MG PER DL)
!VALUE IN DKA
! 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
| rowspan="4" |Arterial blood gas
| colspan="1" rowspan="1" |Alert
|
| colspan="1" rowspan="1" |Alert/drowsy
* Blood pH
| colspan="1" rowspan="1" |Stupor/coma
| rowspan="4" |
* Evaluation of acid-base status of the body
|
* 7.35-7.45
|
* <7.3
|-
|-
| colspan="1" rowspan="1" |Serum bicarbonate
|
| colspan="1" rowspan="1" |15 to 18 mEq per L (15 to 18 mmol per L)
* Serum bicarbonate
| 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)
* 22-26 mEq/L
|
* <18 mEq/L
|-
|-
| colspan="1" rowspan="1" |Serum ketone†
|
| colspan="1" rowspan="1" |Positive
* Arterial CO2
| colspan="1" rowspan="1" |Positive
|
| colspan="1" rowspan="1" |Positive
* 35-45 mmHg
|
* Decreased secondary to hyperventilation as a compensation to metabolic acidosis
|-
|-
| colspan="1" rowspan="1" |Urine ketone†
|
| colspan="1" rowspan="1" |Positive
* Arterial O2
| colspan="1" rowspan="1" |Positive
|
| colspan="1" rowspan="1" |Positive
* 75-100 mmHg
|}
|
 
* Within normal range unless there is concomitant respiratory infection e.g. pneumonia leading to hypoxia)
==== 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" |Anion gap
| colspan="1" rowspan="1" |Essential for evaluation of acid base disorders
| colspan="1" rowspan="1" |
| colspan="1" rowspan="1" |Na– (Cl + HCO3)
* Na– (Cl + HCO3)
| colspan="1" rowspan="1" |7 to 13 mEq per L (7 to 13 mmol per L)
| colspan="1" rowspan="1" |
* Evaluation of acid base disorders
| colspan="1" rowspan="1" |
* 7 to 13 mEq/L (7 to 13 mmol/L)
|
* Increased
|-
|-
| colspan="1" rowspan="1" |Osmolar gap
| colspan="1" rowspan="1" |Osmolar gap
| colspan="1" rowspan="1" |Difference between measured osmolality and calculated osmolality
| colspan="1" rowspan="1" |
| colspan="1" rowspan="1" |Osmolality (measured) – osmolality (calculated)
* Osmolality (measured) – osmolality (calculated)
| colspan="1" rowspan="1" |< 10 mmol per L*
| colspan="1" rowspan="1" |
* Difference between measured osmolality and calculated osmolality
| colspan="1" rowspan="1" |
* < 10 mmol/L
|
* Increased
|-
|-
| colspan="1" rowspan="1" |Serum osmolality
| colspan="1" rowspan="1" |Serum osmolality
| colspan="1" rowspan="1" |Measure of particles in a fluid compartment
| 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)
| colspan="1" rowspan="1" |285 to 295 mOsm per kg (285 to 295 mmol per kg) of water
| 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" |Serum sodium correction
| colspan="1" rowspan="1" |Hyperglycemia causes pseudohyponatremia
| colspan="1" rowspan="1" |
| colspan="1" rowspan="1" |Na + 0.016(glucose – 100)
* Na + 0.016(glucose – 100)
| colspan="1" rowspan="1" |135 to 140 mEq per L (135 to 140 mmol per L)
| 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
|-
|
|
|
|
|
|}
|}


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! colspan="1" rowspan="1" |COMMENTS
! colspan="1" rowspan="1" |COMMENTS
|-
|-
| colspan="2" rowspan="1" |For all patients
| colspan="1" rowspan="1" |HbA1C
|-
| colspan="1" rowspan="1" |A1C
| colspan="1" rowspan="1" |To determine level of glycemic control in persons with diabetes mellitus
| colspan="1" rowspan="1" |To determine level of glycemic control in persons with diabetes mellitus
|-
|-

Revision as of 19:45, 4 August 2017

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Overview

Laboratory Findings

LAB FORMULA/ VARIABLE PURPOSE NORMAL VALUE VALUE IN DKA
Arterial blood gas
  • Blood pH
  • Evaluation of acid-base status of the body
  • 7.35-7.45
  • <7.3
  • Serum bicarbonate
  • 22-26 mEq/L
  • <18 mEq/L
  • Arterial CO2
  • 35-45 mmHg
  • Decreased secondary to hyperventilation as a compensation to metabolic acidosis
  • Arterial O2
  • 75-100 mmHg
  • Within normal range unless there is concomitant respiratory infection e.g. pneumonia leading to hypoxia)
Anion gap
  • Na– (Cl + HCO3)
  • Evaluation of acid base disorders
  • 7 to 13 mEq/L (7 to 13 mmol/L)
  • Increased
Osmolar gap
  • Osmolality (measured) – osmolality (calculated)
  • Difference between measured osmolality and calculated osmolality
  • < 10 mmol/L
  • Increased
Serum osmolality
  • 2(Na + K) + (glucose/18) + (blood urea nitrogen/2.8)
  • 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)
  • Hyperglycemia causes pseudohyponatremia
  • 135 to 140 mEq per L (135 to 140 mmol per L)
  • N/A

Suggested Laboratory Evaluation for Persons with Diabetic Ketoacidosis

TEST COMMENTS
HbA1C 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 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
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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