Diagnostic studies-diabetic ketoacidosis

• ↑ Anion gap metabolic acidosis (pH <7.3 & HCO3 <18): can later develop nonanion gap acidosis due to urinary loss of ketones (HCO3 equiv.) & fluid resuscitation w/ chloride
• Ketosis: ⊕ urine and serum ketones (predominant ketone is β-OH-butyrate, but acetoacetate measured by assay; urine ketones may be ⊕ in fasting normal Pts)
• ↑ Serum glc usually >250 mg/dL (but can be euglycemic if on SGLT-2i);↑ BUN & Cr
• Hyponatremia: corrected Na = measured Na + [2.4 × (measured glc – 100)/100]
• ↓ or ↑ K (but even if serum K is elevated, usually total body K depleted); ↓ total body phos
• Leukocytosis & ↑ amylase (even if no pancreatitis)

Nonspecific hyperamylasemia and hyperlipasemia in diabetic ketoacidosis: incidence and correlation with biochemical abnormalities - PubMed

Conclusions: In DKA nonspecific elevations of amylase and lipase occur in 16-25% of cases. Amylase elevation is correlated with pH and serum osmolality, but lipase elevation is correlated with serum osmolality alone. Diagnosis of AP based soley on elevated amylase or lipase, even > 3 times normal, is not justifiable.

Explain by ChatGPT

• Anion gap metabolic acidosis is when the pH is less than 7.3 and the HCO3 is less than 18. This can later develop into nonanion gap acidosis due to urinary loss of ketones and fluid resuscitation with chloride.
• Ketosis is when there are ketones in the urine and serum. The predominant ketone is β-OH-butyrate, but acetoacetate is measured by assay. Urine ketones may be positive in fasting normal patients.
• The serum glucose is usually increased. hyponatremia is when the corrected Na is measured Na + [2.4 x (measured glucose - 100)/100] 每一百上升2.4

200(+100) ⇒ +2.4 500(+400) ⇒ +9.6

• Potassium may be decreased or increased (but even if the serum potassium is elevated, usually the total body potassium is depleted). Phosphorus is decreased.
• Leukocytosis and amylase are increased (even if there is no pancreatitis).

窩的英文不太好

• 陰離子間隙代謝性酸中毒是指 pH 值低於 7.3 且 HCO3 低於 18。由於尿中酮體丟失和氯離子液體復甦，這會在以後發展為非陰離子間隙酸中毒。
• 酮症是指尿液和血清中含有酮體。主要的酮是 β-OH-丁酸，但乙酰乙酸是通過測定法測量的。空腹正常患者尿酮體可能呈陽性。
• 血糖通常會升高。低鈉血症是當校正的 Na 測量為 Na + [2.4 x（測量的葡萄糖 - 100）/100] 時。
• 鉀可能會減少或增加（但即使血清鉀升高，通常全身鉀也會耗盡）。磷減少。
• 白細胞增多和澱粉酶升高（即使沒有胰腺炎）。