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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