Hyperosmolar hyperglycemic state laboratory findings: Difference between revisions

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==Laboratory Findings==
==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>
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>
{| 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;" + |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;" + |NORMAL VALUE
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" + |VALUE IN DKA
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" + |VALUE IN HHS
|-
|-
| rowspan="4" |[[Arterial blood gas]]  
|[[Arterial blood gas]]  
|
|
* [[Blood]] [[pH]]
* [[Blood]] [[pH]]
| rowspan="4" |
* Evaluation of [[Acid-base balance|acid-base status]] of the body
|
|
* 7.35-7.45
* 7.35-7.45
|
|
* <7.3
* >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" |[[Anion gap]]
| colspan="1" rowspan="1" |
| colspan="1" rowspan="1" |
* Na– (Cl + HCO3)
* Na– (Cl + HCO3)
| colspan="1" rowspan="1" |
* Evaluation of [[Acid base physiology|acid base disorders]]
| colspan="1" rowspan="1" |
| colspan="1" rowspan="1" |
* 7 to 13 mEq/L (7 to 13 mmol/L)
* 7 to 13 mEq/L (7 to 13 mmol/L)
|
|
* Increased (>10 mEq/L required for diagnosis)
* (<12 mEq/L)  
|-
|-
| colspan="1" rowspan="1" |Osmolar gap
| colspan="1" rowspan="1" |Plasma glucose
| colspan="1" rowspan="1" |
* [[Osmolality]] (measured) – [[osmolality]] (calculated)
| colspan="1" rowspan="1" |
| colspan="1" rowspan="1" |
* Difference between measured [[osmolality]] and calculated [[osmolality]]
*  
| colspan="1" rowspan="1" |
| colspan="1" rowspan="1" |
* < 10 mmol/L
* < 200 mg/dl
|
|
* Increased
* >600 mg/dl
|-
|-
| colspan="1" rowspan="1" |[[Osmolality|Serum osmolality]]
| colspan="1" rowspan="1" |[[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)
| colspan="1" rowspan="1" |
* Measure of particles in a [[fluid]] compartment
| colspan="1" rowspan="1" |
| colspan="1" rowspan="1" |
* 285 to 295 mOsm/kg (285 to 295 mmol/kg) of water
* 285 to 295 mOsm/kg (285 to 295 mmol/kg) of water
|
|
* Increased
* Increased (> 320mOsm/kg)
|-
|Plasma and urine ketones
|
|
|Trace or Negative
|-
|Serum Bicarbonate
|
|
|> 15 meq/L
|-
|-
| colspan="1" rowspan="1" |[[Serum]] [[sodium]] correction
|Water deficit
| 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
|9 L
|-
|-
|[[Blood urea nitrogen]], [[creatinine]] levels
|[[Blood urea nitrogen]], [[creatinine]] levels
|
|
* N/A
* N/A
|
* To assess [[renal function]]
|
|
* 7-20 mg/dl
* 7-20 mg/dl
Line 118: Line 91:
|
|
* N/A
* N/A
|
* Assess [[infection]]
* To rule out [[pancreatitis]]
|
|
|
|

Revision as of 22:40, 22 September 2017

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

Overview

An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].

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

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
Arterial blood gas
  • 7.35-7.45
  • >7.3
Anion gap
  • Na– (Cl + HCO3)
  • 7 to 13 mEq/L (7 to 13 mmol/L)
  • (<12 mEq/L)
Plasma glucose
  • < 200 mg/dl
  • >600 mg/dl
Serum osmolality
  • 285 to 295 mOsm/kg (285 to 295 mmol/kg) of water
  • Increased (> 320mOsm/kg)
Plasma and urine ketones Trace or Negative
Serum Bicarbonate > 15 meq/L
Water deficit 9 L
Blood urea nitrogen, creatinine levels
  • N/A
  • 7-20 mg/dl
  • 0.8-1.2mg/dl
Complete blood count (with differential)
  • N/A
  • Increased

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.

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