Dear list members
A young man presented with coma having been previously
fit and well. The relatives gave a history of him
having abdominal pain and vomiting over the last two
days. At the A/E, he was found to be in hypovolaemic
shock with peripheral shutdown. Despite this, a finger
stick blood glucose was performed and the glucometer
reading was 7.6 mmol/L. A urine test showed 4+ glucose
but negative ketones. A venous blood sample was rushed
to the lab which showed a serum glucose of 84.1 mmol/L
and arterial blood gas sample showed severe metabolic
acidosis with pH of 6.9. His serum B-hydroxybutyrate
(BOHB)was > 12.0 mmol/L. The serum sodium was 152
mmol/L, potassium 4.5 mmol/L, osmolality 430 mosm/L,
urea 34 mmol/L and creatinine 481 umol/L. This young
patient presented with unusual hyperosmolar DKA with
predominant production of BOHB that gave a negative
reaction with urine dip stick. Despite the glucometer
SOP warning against use of finger stick sample in
peripherally shut down patients, clinical staff seem
to be unaware of this caveat.
Comments are welcome.
Mohammad
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Dr. M A Al-Jubouri
Consultant Chemical Pathologist
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