In addition to all these good ponits suggested, D-lactate and salicytate should be checked.
 
Qing Meng
 
Date: Thu, 20 Jan 2011 15:26:28 +0000
From: [log in to unmask]
Subject: Re: AKA mimicking DKA
To: [log in to unmask]

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/ ------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/