JISCMail - ACB-CLIN-CHEM-GEN Archives

Sorry Jonathan, that was a copy & paste from telepath screen, the + & - flags represent above & below reference ranges and all resulst are in SI units.

We don't measure plasma ketones, however I suspect that the osmolal gap can be wholly accounted for by ketone bodies as shown previously in DKA cases with high osmolal gap. The patient GCS was 15 and denied taking any toxic substance.

There were no previous measurements as this was the initial sample analysed.

Crucially HbA1c is 5.5%, which makes AKA the more likely diagnosis, however the associated hyperglycaemia is unusual.

The patient was managed initially on a DKA protocol and after two hours the acidosis has improved (pH 7.35) and glucose level was 8.5 mmol/L.

Mohammad

From: Jonathan Kay <[log in to unmask]>
To: [log in to unmask]
Sent: Thu, 20 January, 2011 15:26:28
Subject: Re: AKA mimicking DKA

1 I suggest assaying plasma acetoacetate and betahydroxybutyrate, and blood glycated haemoglobin.

2 Have you checked that osmolar gap on another specimen? If it is confirmed is there any suspicion of consumption of other alcohols?

3 Are there any previous measurements?

4 At this point it looks more like alcoholic ketoacidosis than diabetic ketoacidosis. (Not known to have diabetes, plasma glucose, blood pH, plasma anion gap)

5 I guess the data might have been cut and pasted from another display, but I'd want to put units on those numbers, and I wouldn't precede real numbers with minus signs unless they were negative.

Jonathan

On 20 Jan 2011, at 14:55, Mohammad Al-Jubouri wrote:

A 51-year-old woman presented with abdominal pain, vomiting and hyperventilation, blood tests showed severe metabolic aciodsis, hyperglycaemia and urine showed ketones +++. She is not known to be diabetic and drink some vodka daily, results were as follows:

Biochemistry :

Sodium     - 130

Potassium    3.8

Urea       + 14.8

Creatinine + 120

eGFR           45

Bicarb     - 6.2

Chloride   - 86

Anion gap  + 41.6

S.Osmolal  + 312

Osmolal gap +21

R. Glucose + 16.2

Lactate +3.2

CK           94

CRP          <4

Alcohol   <10

Calc  2.11

Magnesium 0.92

Phosphate 1.26

Bilirubin + 22

GGT          +125

ALT           +49

ALP             99

Albumin      47

Blood gases:

pH         - 7.200
pCO2       - 0.95
pO2        + 17.1

Std Bicarb   7.3
O2 SAT       97.3

Is this DKA or Alcoholic ketoacidosis and how to confirm either?

thanks

Mohammad

Dr. M A Al-Jubouri, MB ChB, MSc, FRCP Edin, FRCPath
Consultant Chemical Pathologist

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------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/ Green Laboratories Work http://www.laboratorymedicine.nhs.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/