Workup-for-AG-metabolic-acidosis

(AJKD 2021;78:A16)

• ✓ for ketonuria (dipstick acetoacetate) or plasma β-hydroxybutyrate (βOHB) nb, urine acetoacetate often not present in early ketoacidosis due to shunting to βOHB; ∴ acetoacetate may later turn ⊕ but does not signify worsening disease
• If ⊖ ketones, ✓ renal function, lactate, toxin screen, and Serum osmolal gap
• If obtunded or ↑↑ AG, check osmolal gap (OG) = measured osmoles – calculated osmoles
• Calculated osmoles = (2 × Na) + (glucose/18) + (BUN/2.8) (+ [EtOH/4.6] if ↑ EtOH level and want to test if other ingestions)
• OG >10 → suggests ingestion (see below) but lacks specificity (can be elevated in lactic acidosis, DKA, and alcoholic ketoacidosis due to acetone)
• High-dose lorazepam (>10 mg/h) a/w propylene glycol intoxication
• OG & AG vary based on timing, initially OG ↑, then ↓ w/ metabolism as AG ↑

Explain by ChatGPT

• Check for ketones in urine (dipstick acetoacetate) or plasma β-hydroxybutyrate (βOHB).
• If there are no ketones, check renal function, lactate, and toxin screen, and Serum osmolal gap.
• If the person is obtunded or there is an ↑↑ AG, check osmolal gap (OG) = measured osmoles – calculated osmoles.
• Calculated osmoles = (2 × Na) + (glucose/18) + (BUN/2.8) (+ [EtOH/4.6] if ↑ EtOH level and want to test if other ingestions).
• OG High-dose lorazepam ( OG & AG vary based on timing, initially OG ↑, then ↓ w/ metabolism as AG ↑.

窩的英文不太好

• 檢查尿液中的酮（試紙乙酰乙酸）或血漿 β-羥基丁酸 (βOHB)。
• 如果沒有酮體，檢查腎功能、乳酸和毒素篩查，以及血清滲透壓間隙。
• 如果此人反應遲鈍或出現 ↑↑ AG，請檢查滲透壓間隙 (OG) = 測量的滲透壓 - 計算的滲透壓。
• 計算的滲透壓 = (2 × Na) + (葡萄糖/18) + (BUN/2.8)（+ [EtOH/4.6] 如果 ↑ EtOH 水平並且想要測試是否有其他攝入）。
• OG 高劑量勞拉西泮（ OG 和 AG 因時間而異，最初 OG ↑，然後 ↓ w/ 新陳代謝為 AG ↑。