Plasma glucose is >600 mg/dL.
Beta-hydroxybutarate is the main product of ketogenesis, with acetoacetic acids constituting the remainder of the ketones.
When measuring serum ketones, the nitroprusside reaction will not detect beta-hydroxybutarate. Thus, serum or urine ketones measured by the nitroprusside reaction may be initially negative at the time of presentation, or remain positive when diabetic ketoacidosis (DKA) has resolved (giving the appearance that there are no ketones in the serum, or that DKA is not resolving).
negative or low
Increased owing to volume depletion.
Increased owing to volume depletion (pre-renal azotemia).
Usually low due to osmotic flux of water from the intracellular to the extracellular space in the presence of hyperglycemia.
The total sodium deficit is 5 to 13 mEq/kg. Hypernatremia in the presence of hyperglycemia indicates profound volume depletion.
variable; usually low but hypernatremia may be present
The total potassium deficit is 4 to 6 mEq/kg owing to increased diuresis.
However, serum potassium is usually elevated owing to extracellular shift of potassium caused by insulin insufficiency, hypertonicity, and acidemia.
Low potassium level on admission indicates severe total-body potassium deficit.
usually elevated; decreased in severe cases
The total chloride deficit is 5 to 15 mEq/kg.
The total body deficit of magnesium is usually 1 to 2 mEq/kg owing to increased magnesium loss from diuresis.
The total body calcium deficit is usually approximately 1 to 2 mEq/kg owing to increased calcium loss from diuresis.
The total body phosphate deficit is 3 to 7 mmol/kg owing to increased phosphate loss from diuresis.
Effective serum osmolality is calculated as: 2 (measured Na [mEq/L]) + (glucose [mg/dL])/18 = mOsm/kg.
Coma, if present, is most often due to hypernatremia rather than hyperglycemia.
Serum lactate is >5 mmol/L in lactic acidosis.
Lactic acid levels can be elevated if concomitant lactic acidosis is present.
Venous pH sample is usually 0.03 units lower than arterial pH.
Several studies have suggested that the difference between venous and arterial pH samples is not sufficiently significant to change clinical management.
arterial pH usually >7.30; arterial bicarbonate is >15 mEq/L
variable; positive for glucose; positive for leukocytes and nitrites in the presence of infection; negative or only mildly positive for ketones
Abnormalities may exist if underlying diseases, such as fatty liver or congestive heart failure, are present.
Used to identify precipitating cardiovascular diseases, such as myocardial infarction (MI), or if severe electrolyte abnormalities are present.
Evidence of hypo- (U waves) or hyperkalemia (tall T waves) may be present.
may show evidence of MI or hyperkalemia or hypokalemia
Should be tested if an myocardial infarction (MI) is suspected as the trigger.
may be elevated in the presence of MI
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