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Which system was used to measure a. The finger prick glucose, b. The urine ketones? Have seen no published evidence of hyperosmolar coma causing this problem since days of BM 1-44 stick. Has anyone else? Tim At Basildon [log in to unmask] -----Original Message----- From: p=NHS NATIONAL INT;a=NHS;c=GB;dda:RFC-822=ACB-CLIN-CHEM-GEN(a)JISCMAIL.AC.UK; Sent: 11 March 2002 16:04 To: p=NHS NATIONAL INT;a=NHS;c=GB;dda:RFC-822=ACB-CLIN-CHEM-GEN(a)JISCMAIL.AC.UK; Subject: Rampant DKA with normal glucose and negative ketones 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 ===== Dr. M A Al-Jubouri Consultant Chemical Pathologist __________________________________________________ Do You Yahoo!? Everything you'll ever need on one web page from News and Sport to Email and Music Charts http://uk.my.yahoo.com ------ACB discussion List Information-------- This is an open discussion list for the academic and clinical community working in clinical biochemistry. Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content. ACB Web Site http://www.acb.org.uk List Archives http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html List Instructions (How to leave etc.) http://www.jiscmail.ac.uk/ ********************************************************************** This email and any files transmitted with it are confidential and intended solely for the use of the individual or entity to whom they are addressed. If you have received this email in error please notify the system manager at mailto:[log in to unmask] This footnote also confirms that this email message has been swept by MIMEsweeper for the presence of computer viruses. www.mimesweeper.com ********************************************************************** ------ACB discussion List Information-------- This is an open discussion list for the academic and clinical community working in clinical biochemistry. Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content. ACB Web Site http://www.acb.org.uk List Archives http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html List Instructions (How to leave etc.) http://www.jiscmail.ac.uk/