Diagnostics

• Check serum glucose to confirm hyperglycemia.

• Check BMP for serum bicarbonate, anion gap, electrolytes, and renal function.

• Check for the presence of ketones.

  • Urine ketones: Standard urine dipstick assays detect acetoacetate and acetone but not beta-hydroxybutyrate.

  • Serum beta-hydroxybutyrate —> Beta-hydroxybutyrate is the most common ketone produced in DKA. Serum measurement is more sensitive than urine ketone measurement and can also be used to monitor the response to therapy.

• Check blood gas analysis for pH.

• Diagnostic workup to evaluate the underlying cause: HbA1c, CBC, ECG, infectious workup

DKA is the diagnosis in patients with type 1 diabetes who have hyperglycemia, ketonuria, and high anion gap metabolic acidosis with decreased bicarbonate!

HHS is the diagnosis in patients with type 2 diabetes who have hyperglycemia and hyperosmolality!

• Sodium:

  • Hyponatremia is common in both DKA and HHS, due to hypovolemic hyponatremia and hypertonic hyponatremia

  • Always check corrected sodium for hyperglycemia.

• Potassium in DKA: normal or elevated (despite a total body deficit)

• Magnesium levels are typically low.

• Phosphorus levels may be elevated despite a total body deficit.

• BUN and creatinine are often elevated

• HbA1c

• Urine pregnancy test

• Diagnostics for AMS, e.g.:

  • CT head

  • Toxicology screen

• Diagnostics for sepsis, e.g.:

  • CBC with differential

  • Serum lactate

• Diagnostics for myocardial infarction, e.g., 12-lead ECG

• Diagnostics for acute abdomen, e.g.:

  • Abdominal imaging

  • Serum lipase [10]

  • Serum transaminases

Infection, myocardial infarction, and panc

Infection, myocardial infarction, and pancreatitis should be ruled out in all patients presenting with a hyperglycemic crisis.