Why Is Sodium High In Dka?

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Correcting Serum Or Plasma Sodium For Hyperglycemia Should Labs Report A Corrected Sodium

​A question recently posted on AACC’s chemistry list-serve involved correcting the serum or plasma sodium concentration for the patient’s degree of hyperglycemia in the setting of DKA. The proposed formula was: corrected sodium = measured sodium + [1.6 (glucose – 100) / 100]. The laboratory would then report a “corrected” serum or plasma sodium in addition to the measured sodium. Would you advise the lab to put this policy into place and report “corrected” sodiums? In general, other than anion gap, eGFR and EAG, I do not recommend providing clinicians with "corrected" or calculated results. If the lab provides a "corrected" result (e.g., calculated osmolality based upon sodium, glucose and BUN, or total calcium is corrected for changes in albumin, or the sodium is corrected for changes in glucose), the reporting of such a result “validates” the assumptions that were made in determining the correction. However, assumptions are only “assumptions” and it is unknown whether the assumptions really do apply to the case in question. In short, the calculation estimates are not necessarily correct and should not be reported. A good example of how assumptions can be f Continue reading >>

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Popular Questions

  1. launchpad

    can anyone plz tell me what happens to the Na and K levels in DKA.kaplan says there is hypernatremia and hypokalemia.

  2. frontal

    There is no hypernatremia in DKA. There is electrolyte loss in DKA primariy due to hyperglycemia causing osmotic diuresis, so the patient is depleted of both Na and K, but the serum levels of potassium maybe normal or even elevated. This is because of a disproportionate loss of water (osmotic diuresis) and because of acidosis, which forces the hydrogen ions into cells in exchange for K ions. Remember: a patient with DKA is potassium depleted, even if serum potassium values are on the higher side at presentation. Renal loss continues and as treatment with insulin is started, a fall in serum potassium is likely to be observed because insulin pushes the K ions back into the cells. Electrolye monitoring is necessary while treating the patient, so that insulin dose can be adjusted and fluids given appropriately.

  3. frontal

    A normal serum sodium level in DKA would indicate profound dehydration.

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