Hyperosmolar hyperglycemic state laboratory findings: Difference between revisions
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{{Hyperosmolar hyperglycemic state}} | {{Hyperosmolar hyperglycemic state}} | ||
{{CMG}}; {{AE}} | {{CMG}}; {{AE}} {{HS}} | ||
==Overview== | ==Overview== | ||
Laboratory findings consistent with the diagnosis of hyperosmolar hyperglycemic state (HHS) include [[plasma glucose]] > 600 mg/dl, [[serum]] [[osmolarity]] > 320 mOsm/kg, [[blood]] [[pH]] > 7.3, [[serum]] [[bicarbonate]] > 18 mEq/L and negative or trace positive urine or serum [[ketones]]. | |||
Laboratory findings consistent with the diagnosis of [ | |||
[ | |||
==Laboratory Findings== | ==Laboratory Findings== | ||
The following lab abnormalities may be found in hyperosmolar hyperglycemic state (HHS):<ref name="pmid19564476">{{cite journal |vauthors=Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN |title=Hyperglycemic crises in adult patients with diabetes |journal=Diabetes Care |volume=32 |issue=7 |pages=1335–43 |year=2009 |pmid=19564476 |pmc=2699725 |doi=10.2337/dc09-9032 |url=}}</ref><ref name="pmid12668546">{{cite journal |vauthors=Chiasson JL, Aris-Jilwan N, Bélanger R, Bertrand S, Beauregard H, Ekoé JM, Fournier H, Havrankova J |title=Diagnosis and treatment of diabetic ketoacidosis and the hyperglycemic hyperosmolar state |journal=CMAJ |volume=168 |issue=7 |pages=859–66 |year=2003 |pmid=12668546 |pmc=151994 |doi= |url=}}</ref><ref name="pmid25325058">{{cite journal |vauthors=Liamis G, Liberopoulos E, Barkas F, Elisaf M |title=Diabetes mellitus and electrolyte disorders |journal=World J Clin Cases |volume=2 |issue=10 |pages=488–96 |year=2014 |pmid=25325058 |pmc=4198400 |doi=10.12998/wjcc.v2.i10.488 |url=}}</ref><ref name="pmid3084904">{{cite journal |vauthors=Adrogué HJ, Lederer ED, Suki WN, Eknoyan G |title=Determinants of plasma potassium levels in diabetic ketoacidosis |journal=Medicine (Baltimore) |volume=65 |issue=3 |pages=163–72 |year=1986 |pmid=3084904 |doi= |url=}}</ref><ref name="pmid23630441">{{cite journal |vauthors=Xu W, Wu HF, Ma SG, Bai F, Hu W, Jin Y, Liu H |title=Correlation between peripheral white blood cell counts and hyperglycemic emergencies |journal=Int J Med Sci |volume=10 |issue=6 |pages=758–65 |year=2013 |pmid=23630441 |pmc=3638300 |doi=10.7150/ijms.6155 |url=}}</ref><ref name="pmid6773457">{{cite journal |vauthors=Molitch ME, Rodman E, Hirsch CA, Dubinsky E |title=Spurious serum creatinine elevations in ketoacidosis |journal=Ann. Intern. Med. |volume=93 |issue=2 |pages=280–1 |year=1980 |pmid=6773457 |doi= |url=}}</ref><ref name="pmid10970986">{{cite journal |vauthors=Gokel Y, Paydas S, Koseoglu Z, Alparslan N, Seydaoglu G |title=Comparison of blood gas and acid-base measurements in arterial and venous blood samples in patients with uremic acidosis and diabetic ketoacidosis in the emergency room |journal=Am. J. Nephrol. |volume=20 |issue=4 |pages=319–23 |year=2000 |pmid=10970986 |doi= | The following lab abnormalities may be found in hyperosmolar hyperglycemic state (HHS):<ref name="pmid19564476">{{cite journal |vauthors=Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN |title=Hyperglycemic crises in adult patients with diabetes |journal=Diabetes Care |volume=32 |issue=7 |pages=1335–43 |year=2009 |pmid=19564476 |pmc=2699725 |doi=10.2337/dc09-9032 |url=}}</ref><ref name="pmid12668546">{{cite journal |vauthors=Chiasson JL, Aris-Jilwan N, Bélanger R, Bertrand S, Beauregard H, Ekoé JM, Fournier H, Havrankova J |title=Diagnosis and treatment of diabetic ketoacidosis and the hyperglycemic hyperosmolar state |journal=CMAJ |volume=168 |issue=7 |pages=859–66 |year=2003 |pmid=12668546 |pmc=151994 |doi= |url=}}</ref><ref name="pmid25325058">{{cite journal |vauthors=Liamis G, Liberopoulos E, Barkas F, Elisaf M |title=Diabetes mellitus and electrolyte disorders |journal=World J Clin Cases |volume=2 |issue=10 |pages=488–96 |year=2014 |pmid=25325058 |pmc=4198400 |doi=10.12998/wjcc.v2.i10.488 |url=}}</ref><ref name="pmid3084904">{{cite journal |vauthors=Adrogué HJ, Lederer ED, Suki WN, Eknoyan G |title=Determinants of plasma potassium levels in diabetic ketoacidosis |journal=Medicine (Baltimore) |volume=65 |issue=3 |pages=163–72 |year=1986 |pmid=3084904 |doi= |url=}}</ref><ref name="pmid23630441">{{cite journal |vauthors=Xu W, Wu HF, Ma SG, Bai F, Hu W, Jin Y, Liu H |title=Correlation between peripheral white blood cell counts and hyperglycemic emergencies |journal=Int J Med Sci |volume=10 |issue=6 |pages=758–65 |year=2013 |pmid=23630441 |pmc=3638300 |doi=10.7150/ijms.6155 |url=}}</ref><ref name="pmid6773457">{{cite journal |vauthors=Molitch ME, Rodman E, Hirsch CA, Dubinsky E |title=Spurious serum creatinine elevations in ketoacidosis |journal=Ann. Intern. Med. |volume=93 |issue=2 |pages=280–1 |year=1980 |pmid=6773457 |doi= |url=}}</ref><ref name="pmid10970986">{{cite journal |vauthors=Gokel Y, Paydas S, Koseoglu Z, Alparslan N, Seydaoglu G |title=Comparison of blood gas and acid-base measurements in arterial and venous blood samples in patients with uremic acidosis and diabetic ketoacidosis in the emergency room |journal=Am. J. Nephrol. |volume=20 |issue=4 |pages=319–23 |year=2000 |pmid=10970986 |doi=10.1159/000013607|url=}}</ref> | ||
{| class="wikitable" | {| class="wikitable" | ||
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" + |LAB | ! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" + |LAB | ||
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" + | FORMULA/ VARIABLE | ! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" + |FORMULA/ VARIABLE | ||
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" + |NORMAL VALUE | ! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" + |NORMAL VALUE | ||
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" + |VALUE IN HHS | ! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" + |VALUE IN HHS | ||
|- | |- | ||
|[[Plasma glucose]] (mg/dL) | | align="center" style="background:#DCDCDC;" + |[[Plasma glucose]] (mg/dL) | ||
| | | | ||
|< 200 mg/dl | * Direct measurement | ||
|> 600 mg/dl | | | ||
* < 200 mg/dl | |||
| | |||
* > 600 mg/dl | |||
|- | |- | ||
| | | align="center" style="background:#DCDCDC;" + |Arterial pH | ||
| | | | ||
* [[Blood]] [[pH]] | * [[Blood]] [[pH]] | ||
| Line 44: | Line 31: | ||
* > 7.30 | * > 7.30 | ||
|- | |- | ||
| colspan="1" rowspan="1" |[[Anion gap]] | | colspan="1" rowspan="1" align="center" style="background:#DCDCDC;" + |[[Anion gap]] | ||
| colspan="1" rowspan="1" | | | colspan="1" rowspan="1" | | ||
* (Na+) – ( | * (Na<sup>+</sup>) – (Cl<sup>–</sup> + HCO3<sup>–</sup>) | ||
| colspan="1" rowspan="1" | | | colspan="1" rowspan="1" | | ||
* 7 to 13 (mEq/L) | * 7 to 13 (mEq/L) | ||
| Line 52: | Line 39: | ||
* Variable | * Variable | ||
|- | |- | ||
| colspan="1" rowspan="1" |[[Osmolality|Serum osmolality]] | | colspan="1" rowspan="1" align="center" style="background:#DCDCDC;" + |[[Osmolality|Serum osmolality]] | ||
| colspan="1" rowspan="1" | | | colspan="1" rowspan="1" | | ||
* 2([[Sodium|Na]] + [[Potassium|K]]) + ([[glucose]]/18) + ([[blood]] [[urea]] [[nitrogen]]/2.8) | * 2([[Sodium|Na]] + [[Potassium|K]]) + ([[glucose]]/18) + ([[blood]] [[urea]] [[nitrogen]]/2.8) | ||
| Line 60: | Line 47: | ||
* Increased (> 320mOsm/kg) | * Increased (> 320mOsm/kg) | ||
|- | |- | ||
|[[ | | align="center" style="background:#DCDCDC;" + |Plasma [[ketones]] | ||
| | |||
* Direct measurement | |||
| | | | ||
* Negative | |||
| | | | ||
* Trace or negative | |||
|- | |- | ||
|[[ | | align="center" style="background:#DCDCDC;" + |Urine [[ketones]] | ||
| | | | ||
* Direct measurement | |||
| | | | ||
* Negative | |||
| | | | ||
* Trace or negative | |||
|- | |- | ||
|[[ | | align="center" style="background:#DCDCDC;" + |[[Serum bicarbonate]] | ||
| | | | ||
* | * Direct measurement | ||
| | | | ||
* | * 23 - 29 mEq/L | ||
| | | | ||
* | * > 18 mEq/L | ||
|- | |- | ||
|[[ | | align="center" style="background:#DCDCDC;" + |[[Blood urea nitrogen]] ([[BUN]]), [[creatinine]] levels | ||
| | | | ||
* N/A | * N/A | ||
| | | | ||
* | * [[BUN]]: 7-20 mg/dl | ||
* [[Creatinine]] levels: 0.8-1.2mg/dl | |||
| | |||
* Increased ([[Dehydration]] and decreased [[renal]] [[perfusion]]) | |||
|} | |} | ||
| Line 97: | Line 86: | ||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
[[Category:Medicine]] | |||
[[Category:Endocrinology]] | |||
[[Category:Up-To-Date]] | |||
| |||
[[Category:Emergency medicine]] | |||
Latest revision as of 18:19, 23 October 2017
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Hyperosmolar hyperglycemic state Microchapters |
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Differentiating Hyperosmolar hyperglycemic state from other Diseases |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Husnain Shaukat, M.D [2]
Overview
Laboratory findings consistent with the diagnosis of hyperosmolar hyperglycemic state (HHS) include plasma glucose > 600 mg/dl, serum osmolarity > 320 mOsm/kg, blood pH > 7.3, serum bicarbonate > 18 mEq/L and negative or trace positive urine or serum ketones.
Laboratory Findings
The following lab abnormalities may be found in hyperosmolar hyperglycemic state (HHS):[1][2][3][4][5][6][7]
| LAB | FORMULA/ VARIABLE | NORMAL VALUE | VALUE IN HHS |
|---|---|---|---|
| Plasma glucose (mg/dL) |
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| Arterial pH |
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| Anion gap |
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| Serum osmolality |
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| Plasma ketones |
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| Urine ketones |
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| Serum bicarbonate |
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| Blood urea nitrogen (BUN), creatinine levels |
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References
- ↑ Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN (2009). "Hyperglycemic crises in adult patients with diabetes". Diabetes Care. 32 (7): 1335–43. doi:10.2337/dc09-9032. PMC 2699725. PMID 19564476.
- ↑ Chiasson JL, Aris-Jilwan N, Bélanger R, Bertrand S, Beauregard H, Ekoé JM, Fournier H, Havrankova J (2003). "Diagnosis and treatment of diabetic ketoacidosis and the hyperglycemic hyperosmolar state". CMAJ. 168 (7): 859–66. PMC 151994. PMID 12668546.
- ↑ Liamis G, Liberopoulos E, Barkas F, Elisaf M (2014). "Diabetes mellitus and electrolyte disorders". World J Clin Cases. 2 (10): 488–96. doi:10.12998/wjcc.v2.i10.488. PMC 4198400. PMID 25325058.
- ↑ Adrogué HJ, Lederer ED, Suki WN, Eknoyan G (1986). "Determinants of plasma potassium levels in diabetic ketoacidosis". Medicine (Baltimore). 65 (3): 163–72. PMID 3084904.
- ↑ Xu W, Wu HF, Ma SG, Bai F, Hu W, Jin Y, Liu H (2013). "Correlation between peripheral white blood cell counts and hyperglycemic emergencies". Int J Med Sci. 10 (6): 758–65. doi:10.7150/ijms.6155. PMC 3638300. PMID 23630441.
- ↑ Molitch ME, Rodman E, Hirsch CA, Dubinsky E (1980). "Spurious serum creatinine elevations in ketoacidosis". Ann. Intern. Med. 93 (2): 280–1. PMID 6773457.
- ↑ Gokel Y, Paydas S, Koseoglu Z, Alparslan N, Seydaoglu G (2000). "Comparison of blood gas and acid-base measurements in arterial and venous blood samples in patients with uremic acidosis and diabetic ketoacidosis in the emergency room". Am. J. Nephrol. 20 (4): 319–23. doi:10.1159/000013607. PMID 10970986.