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How Do You Test For Ketoacidosis?

Diabetic Ketoacidosis

Diabetic Ketoacidosis

show all detail Diagnostic Tests 1st Tests To Order Test Result plasma glucose To access clinical pearls and in-depth diagnosis and treatment information, sign up for a FREE Epocrates Online account. Sign Up Now! Current Members - Sign In elevated ABG To access clinical pearls and in-depth diagnosis and treatment information, sign up for a FREE Epocrates Online account. Sign Up Now! Current Members - Sign In pH varies from 7.00 to 7.30 in DKA; arterial bicarbonate ranges from <10 mEq/L in severe DKA to >15 mEq/L in mild DKA capillary or serum ketones To access clinical pearls and in-depth diagnosis and treatment information, sign up for a FREE Epocrates Online account. Sign Up Now! Current Members - Sign In beta-hydroxybutyrate elevated ≥3.8 mmol/L in adults or ≥3.0 mmol/L in children U/A To access clinical pearls and in-depth diagnosis and treatment information, sign up for a FREE Epocrates Online account. Sign Up Now! Current Members - Sign In positive for glucose and ketones; positive for leukocytes and nitrites in the presence of infection serum BUN To access clinical pearls and in-depth diagnosis and treatment information, sign up for a FREE Epocrates Online account. Sign Up Now! Current Members - Sign In elevated serum creatinine To access clinical pearls and in-depth diagnosis and treatment information, sign up for a FREE Epocrates Online account. Sign Up Now! Current Members - Sign In elevated serum sodium To access clinical pearls and in-depth diagnosis and treatment information, sign up for a FREE Epocrates Online account. Sign Up Now! Current Members - Sign In usually low serum potassium To access clinical pearls and in-depth diagnosis and treatment information, sign up for a FREE Epocrates Online account. Sign Up Now! Current Members - Sign In usually el Continue reading >>

Diabetic Ketoacidosis (dka) - Topic Overview

Diabetic Ketoacidosis (dka) - Topic Overview

Diabetic ketoacidosis (DKA) is a life-threatening condition that develops when cells in the body are unable to get the sugar (glucose) they need for energy because there is not enough insulin. When the sugar cannot get into the cells, it stays in the blood. The kidneys filter some of the sugar from the blood and remove it from the body through urine. Because the cells cannot receive sugar for energy, the body begins to break down fat and muscle for energy. When this happens, ketones, or fatty acids, are produced and enter the bloodstream, causing the chemical imbalance (metabolic acidosis) called diabetic ketoacidosis. Ketoacidosis can be caused by not getting enough insulin, having a severe infection or other illness, becoming severely dehydrated, or some combination of these things. It can occur in people who have little or no insulin in their bodies (mostly people with type 1 diabetes but it can happen with type 2 diabetes, especially children) when their blood sugar levels are high. Your blood sugar may be quite high before you notice symptoms, which include: Flushed, hot, dry skin. Feeling thirsty and urinating a lot. Drowsiness or difficulty waking up. Young children may lack interest in their normal activities. Rapid, deep breathing. A strong, fruity breath odor. Loss of appetite, belly pain, and vomiting. Confusion. Laboratory tests, including blood and urine tests, are used to confirm a diagnosis of diabetic ketoacidosis. Tests for ketones are available for home use. Keep some test strips nearby in case your blood sugar level becomes high. When ketoacidosis is severe, it must be treated in the hospital, often in an intensive care unit. Treatment involves giving insulin and fluids through your vein and closely watching certain chemicals in your blood (electrolyt Continue reading >>

Point-of-care Screening For Diabetic Ketoacidosis

Point-of-care Screening For Diabetic Ketoacidosis

Summarized from Arora S, Henderson S, Long T, Menchine M. Diagnostic accuracy of point of care testing for diabetic ketoacidosis at Emergency Department triage. Diabetes Care 2011; 34: 852-54 Diabetic ketoacidosis (DKA), a common acute and potentially life-threatening complication of diabetes that results from insulin deficiency, is characterized by raised blood glucose (hyperglycemia) and metabolic acidosis. Metabolic acidosis occurs due to abnormal accumulation in blood of ketoacids, principally ß-hydroxybutyric acid and acetoacetic acid. In an emergency care setting it is common practice to screen all patients with hyperglycemia for DKA using urine dipstick testing for the presence of ketones (i.e. the two ketoacids and acetone, a metabolite of acetoacetic acid). An alternative approach is now available, made possible by the development of point-of-care analyzers that allow rapid (within 1 minute) estimation of serum ß-hydroxybutyrate concentration from a drop of venous blood. The latest of several studies comparing the reliability of traditional urine dipstick testing with that of the newer point-of-care blood testing to diagnose DKA is recently published. The study population comprised 516 patients who on routine triage testing following admission to the emergency department of a Californian hospital were found to have blood glucose in excess of 250 mg/dL (13.9 mmol/L). All were submitted for DKA screening using both urine dipstick testing for ketones and point-of-care blood measurement of serum ß-hydroxybutyrate concentration. A diagnosis of DKA was ultimately confirmed in 54 of the 516 hyperglycemic patients. Urine dipstick testing for ketones was positive in 53 of the 54 patients with DKA (sensitivity 98.1 %) but was also positive in 300 of the 462 patients w Continue reading >>

Diagnosis

Diagnosis

Print If your doctor suspects diabetic ketoacidosis, he or she will do a physical exam and various blood tests. In some cases, additional tests may be needed to help determine what triggered the diabetic ketoacidosis. Blood tests Blood tests used in the diagnosis of diabetic ketoacidosis will measure: Blood sugar level. If there isn't enough insulin in your body to allow sugar to enter your cells, your blood sugar level will rise (hyperglycemia). As your body breaks down fat and protein for energy, your blood sugar level will continue to rise. Ketone level. When your body breaks down fat and protein for energy, acids known as ketones enter your bloodstream. Blood acidity. If you have excess ketones in your blood, your blood will become acidic (acidosis). This can alter the normal function of organs throughout your body. Additional tests Your doctor may order tests to identify underlying health problems that might have contributed to diabetic ketoacidosis and to check for complications. Tests might include: Blood electrolyte tests Urinalysis Chest X-ray A recording of the electrical activity of the heart (electrocardiogram) Treatment If you're diagnosed with diabetic ketoacidosis, you might be treated in the emergency room or admitted to the hospital. Treatment usually involves: Fluid replacement. You'll receive fluids — either by mouth or through a vein (intravenously) — until you're rehydrated. The fluids will replace those you've lost through excessive urination, as well as help dilute the excess sugar in your blood. Electrolyte replacement. Electrolytes are minerals in your blood that carry an electric charge, such as sodium, potassium and chloride. The absence of insulin can lower the level of several electrolytes in your blood. You'll receive electrolytes throu Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

A Preventable Crisis People who have had diabetic ketoacidosis, or DKA, will tell you it’s worse than any flu they’ve ever had, describing an overwhelming feeling of lethargy, unquenchable thirst, and unrelenting vomiting. “It’s sort of like having molasses for blood,” says George. “Everything moves so slow, the mouth can feel so dry, and there is a cloud over your head. Just before diagnosis, when I was in high school, I would get out of a class and go to the bathroom to pee for about 10–12 minutes. Then I would head to the water fountain and begin drinking water for minutes at a time, usually until well after the next class had begun.” George, generally an upbeat person, said that while he has experienced varying degrees of DKA in his 40 years or so of having diabetes, “…at its worst, there is one reprieve from its ill feeling: Unfortunately, that is a coma.” But DKA can be more than a feeling of extreme discomfort, and it can result in more than a coma. “It has the potential to kill,” says Richard Hellman, MD, past president of the American Association of Clinical Endocrinologists. “DKA is a medical emergency. It’s the biggest medical emergency related to diabetes. It’s also the most likely time for a child with diabetes to die.” DKA occurs when there is not enough insulin in the body, resulting in high blood glucose; the person is dehydrated; and too many ketones are present in the bloodstream, making it acidic. The initial insulin deficit is most often caused by the onset of diabetes, by an illness or infection, or by not taking insulin when it is needed. Ketones are your brain’s “second-best fuel,” Hellman says, with glucose being number one. If you don’t have enough glucose in your cells to supply energy to your brain, yo Continue reading >>

Urine Test Kits

Urine Test Kits

What is the difference between the urine test kits for people with diabetes? Three different kinds of urine testing kits are available for testing three different substances in the urine: glucose (sugar), ketones, and microscopic amounts of protein (microalbuminuria). Glucose test kits Before the development of blood glucose meters, urine testing was the only method for gauging a person's sugar levels. However, it has always been a very imprecise method for testing glucose levels for a variety of reasons: Urine test strips cannot detect glucose (sugar) until the blood glucose level is above 180 mg/dl. This means a person's blood sugar level could still be high (hyperglycemia) or even dangerously low (hypoglycemia) but still not be detected. Urine glucose testing is highly subject to user error because it requires color interpretation of the urine test strip via a color-scale comparison. This becomes an issue with people who are colorblind or have poor eyesight, and certain drugs and vitamin C can change the color of the urine and thus provide an invalid measurement. The reading reflects the level of blood glucose from a few hours earlier - not at the present moment - and often is misinterpreted. As a result of these shortcomings, healthcare professionals recommend that anyone needing to closely monitor blood glucose levels use a blood glucose meter. However, urine strips can be useful in certain populations who physically cannot or will not test themselves with a blood glucose meter. Ketone test kits Ketone bodies are the byproducts of the body burning fat, rather than glucose, to provide energy. When fat is used for energy instead of glucose, the preferred fuel source, the liver produces substances called ketones. If ketones build up, they can lead to a life-threatenin Continue reading >>

Diagnostic Accuracy Of Point-of-care Testing For Diabetic Ketoacidosis At Emergency-department Triage

Diagnostic Accuracy Of Point-of-care Testing For Diabetic Ketoacidosis At Emergency-department Triage

OBJECTIVE In the emergency department, hyperglycemic patients are screened for diabetic ketoacidosis (DKA) via a urine dipstick. In this prospective study, we compared the test characteristics of point-of-care β-hydroxybutyrate (β-OHB) analysis with the urine dipstick. RESEARCH DESIGN AND METHODS Emergency-department patients with blood glucose ≥250 mg/dL had urine dipstick, chemistry panel, venous blood gas, and capillary β-OHB measurements. DKA was diagnosed according to American Diabetes Association criteria. RESULTS Of 516 hyperglycemic subjects, 54 had DKA. The urine dipstick had a sensitivity of 98.1% (95% CI 90.1–100), a specificity of 35.1% (30.7–39.6), a positive predictive value of 15% (11.5–19.2), and a negative predictive value of 99.4% (96.6–100) for DKA. Using the manufacturer-suggested cutoff of >1.5 mmol/L, β-OHB had a sensitivity of 98.1% (90.1–100), a specificity of 78.6% (74.5–82.2), a positive predictive value of 34.9% (27.3–43), and a negative predictive value of 99.7% (98.5–100) for DKA. CONCLUSIONS Point-of-care β-OHB and the urine dipstick are equally sensitive for detecting DKA (98.1%). However, β-OHB is more specific (78.6 vs. 35.1%), offering the potential to significantly reduce unnecessary DKA work-ups among hyperglycemic patients in the emergency department. RESEARCH DESIGN AND METHODS This prospective, observational study was conducted at a large, urban emergency department. Institutional review board approval was obtained, and study participants provided written informed consent. The cohort studied represents a convenience sample of emergency-department patients with triage capillary blood glucose ≥250 mg/dL enrolled on 320 individual days over a 2-year period based on research-assistant availability. Subjects we Continue reading >>

Diabetic Ketoacidosis: Evaluation And Treatment

Diabetic Ketoacidosis: Evaluation And Treatment

Diabetic ketoacidosis is characterized by a serum glucose level greater than 250 mg per dL, a pH less than 7.3, a serum bicarbonate level less than 18 mEq per L, an elevated serum ketone level, and dehydration. Insulin deficiency is the main precipitating factor. Diabetic ketoacidosis can occur in persons of all ages, with 14 percent of cases occurring in persons older than 70 years, 23 percent in persons 51 to 70 years of age, 27 percent in persons 30 to 50 years of age, and 36 percent in persons younger than 30 years. The case fatality rate is 1 to 5 percent. About one-third of all cases are in persons without a history of diabetes mellitus. Common symptoms include polyuria with polydipsia (98 percent), weight loss (81 percent), fatigue (62 percent), dyspnea (57 percent), vomiting (46 percent), preceding febrile illness (40 percent), abdominal pain (32 percent), and polyphagia (23 percent). Measurement of A1C, blood urea nitrogen, creatinine, serum glucose, electrolytes, pH, and serum ketones; complete blood count; urinalysis; electrocardiography; and calculation of anion gap and osmolar gap can differentiate diabetic ketoacidosis from hyperosmolar hyperglycemic state, gastroenteritis, starvation ketosis, and other metabolic syndromes, and can assist in diagnosing comorbid conditions. Appropriate treatment includes administering intravenous fluids and insulin, and monitoring glucose and electrolyte levels. Cerebral edema is a rare but severe complication that occurs predominantly in children. Physicians should recognize the signs of diabetic ketoacidosis for prompt diagnosis, and identify early symptoms to prevent it. Patient education should include information on how to adjust insulin during times of illness and how to monitor glucose and ketone levels, as well as i Continue reading >>

Urine Ketone Dip Test As A Screen For Ketonemia In Diabetic Ketoacidosis Andketosis In The Emergency Department.

Urine Ketone Dip Test As A Screen For Ketonemia In Diabetic Ketoacidosis Andketosis In The Emergency Department.

Urine ketone dip test as a screen for ketonemia in diabetic ketoacidosis andketosis in the emergency department. (1)Department of Emergency Medicine, University Medical Center, Fresno, CA, USA. STUDY OBJECTIVE: To determine the sensitivity of the urine ketone dip test (UKDT)for the detection of ketonemia in patients with diabetic ketoacidosis (DKA) anddiabetic ketosis (DK) in the ED.METHODS: We conducted a retrospective chart review in the ED of an urban,university-affiliated county teaching hospital. The study population comprisedpatients seen in the ED during 1994 and 1995 with a discharge diagnosis of DKA orDK and underwent urinalysis within 4 hours of the initial serum electrolyte andketone determinations. We calculated test sensitivity, along with 95% confidence intervals (CIs).RESULTS: One hundred forty-eight patients with 223 occurrences diagnosed as DKAor DK were seen in the ED during the study period. One hundred fourteen patients with 146 occurrences of DKA or DK met all inclusion criteria; these patients madeup the study group. There were 99 cases of DKA and 47 cases of DK. Thesensitivity of the UKDT for the detection of ketonemia in all patients with DKAor DK was 97% (95% CI, 94% to 99%). In the subgroup of patients with DKA, thesensitivity of the UK was 97% (95% CI, 92% to 99%). For patients with DK, thesensitivity of the UK was 98% (95% CI, 89% to 99%).CONCLUSION: The UKDT is highly sensitive for the presence of serum ketones inpatients with DKA and DK. Prospective study is suggested to determine thespecificity of the UKDT in this application and to validate its use as ascreening tool for the detection of ketonemia in DKA and DK. Continue reading >>

Ketosis Vs. Ketoacidosis: What You Should Know

Ketosis Vs. Ketoacidosis: What You Should Know

Despite the similarity in name, ketosis and ketoacidosis are two different things. Ketoacidosis refers to diabetic ketoacidosis (DKA) and is a complication of type 1 diabetes mellitus. It’s a life-threatening condition resulting from dangerously high levels of ketones and blood sugar. This combination makes your blood too acidic, which can change the normal functioning of internal organs like your liver and kidneys. It’s critical that you get prompt treatment. DKA can occur very quickly. It may develop in less than 24 hours. It mostly occurs in people with type 1 diabetes whose bodies do not produce any insulin. Several things can lead to DKA, including illness, improper diet, or not taking an adequate dose of insulin. DKA can also occur in individuals with type 2 diabetes who have little or no insulin production. Ketosis is the presence of ketones. It’s not harmful. You can be in ketosis if you’re on a low-carbohydrate diet or fasting, or if you’ve consumed too much alcohol. If you have ketosis, you have a higher than usual level of ketones in your blood or urine, but not high enough to cause acidosis. Ketones are a chemical your body produces when it burns stored fat. Some people choose a low-carb diet to help with weight loss. While there is some controversy over their safety, low-carb diets are generally fine. Talk to your doctor before beginning any extreme diet plan. DKA is the leading cause of death in people under 24 years old who have diabetes. The overall death rate for ketoacidosis is 2 to 5 percent. People under the age of 30 make up 36 percent of DKA cases. Twenty-seven percent of people with DKA are between the ages of 30 and 50, 23 percent are between the ages of 51 and 70, and 14 percent are over the age of 70. Ketosis may cause bad breath. Ket Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

As fat is broken down, acids called ketones build up in the blood and urine. In high levels, ketones are poisonous. This condition is known as ketoacidosis. Diabetic ketoacidosis (DKA) is sometimes the first sign of type 1 diabetes in people who have not yet been diagnosed. It can also occur in someone who has already been diagnosed with type 1 diabetes. Infection, injury, a serious illness, missing doses of insulin shots, or surgery can lead to DKA in people with type 1 diabetes. People with type 2 diabetes can also develop DKA, but it is less common. It is usually triggered by uncontrolled blood sugar, missing doses of medicines, or a severe illness. Continue reading >>

Diabetic Ketoacidosisworkup

Diabetic Ketoacidosisworkup

Author: Osama Hamdy, MD, PhD; Chief Editor: Romesh Khardori, MD, PhD, FACP more... Diabetic ketoacidosis is typically characterized by hyperglycemia over 250 mg/dL, a bicarbonate level less than 18 mEq/L, and a pH less than 7.30, with ketonemia and ketonuria. While definitions vary, mild DKA can be categorized by a pH level of 7.25-7.3 and a serum bicarbonate level between 15-18 mEq/L; moderate DKA can be categorized by a pH between 7.0-7.24 and a serum bicarbonate level of 10 to less than 15 mEq/L; and severe DKA has a pH less than 7.0 and bicarbonate less than 10 mEq/L. [ 17 ] In mild DKA, anion gap is greater than 10 and in moderate or severe DKA the anion gap is greater than 12. These figures differentiate DKA from HHS where blood glucose is greater than 600 mg/dL but pH is greater than 7.3 and serum bicarbonate greater than 15 mEq/L. Laboratory studies for diabetic ketoacidosis (DKA) should be scheduled as follows: Blood tests for glucose every 1-2 h until patient is stable, then every 4-6 h Serum electrolyte determinations every 1-2 h until patient is stable, then every 4-6 h Glaser NS, Marcin JP, Wootton-Gorges SL, et al. Correlation of clinical and biochemical findings with diabetic ketoacidosis-related cerebral edema in children using magnetic resonance diffusion-weighted imaging. J Pediatr. 2008 Jun 25. [Medline] . Umpierrez GE, Jones S, Smiley D, et al. Insulin analogs versus human insulin in the treatment of patients with diabetic ketoacidosis: a randomized controlled trial. Diabetes Care. 2009 Jul. 32(7):1164-9. [Medline] . [Full Text] . Herrington WG, Nye HJ, Hammersley MS, Watkinson PJ. Are arterial and venous samples clinically equivalent for the estimation of pH, serum bicarbonate and potassium concentration in critically ill patients?. Diabet Med. 201 Continue reading >>

Diagnostic Accuracy Of Point-of-care Testing For Diabetic Ketoacidosis At Emergency-department Triage

Diagnostic Accuracy Of Point-of-care Testing For Diabetic Ketoacidosis At Emergency-department Triage

Diagnostic Accuracy of Point-of-Care Testing for Diabetic Ketoacidosis at Emergency-Department Triage -Hydroxybutyrate versus the urine dipstick Department of Clinical Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California Corresponding author: Sanjay Arora, [email protected] . Received 2010 Oct 4; Accepted 2011 Jan 7. Copyright 2011 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See for details. This article has been cited by other articles in PMC. In the emergency department, hyperglycemic patients are screened for diabetic ketoacidosis (DKA) via a urine dipstick. In this prospective study, we compared the test characteristics of point-of-care -hydroxybutyrate (-OHB) analysis with the urine dipstick. Emergency-department patients with blood glucose 250 mg/dL had urine dipstick, chemistry panel, venous blood gas, and capillary -OHB measurements. DKA was diagnosed according to American Diabetes Association criteria. Of 516 hyperglycemic subjects, 54 had DKA. The urine dipstick had a sensitivity of 98.1% (95% CI 90.1100), a specificity of 35.1% (30.739.6), a positive predictive value of 15% (11.519.2), and a negative predictive value of 99.4% (96.6100) for DKA. Using the manufacturer-suggested cutoff of >1.5 mmol/L, -OHB had a sensitivity of 98.1% (90.1100), a specificity of 78.6% (74.582.2), a positive predictive value of 34.9% (27.343), and a negative predictive value of 99.7% (98.5100) for DKA. Point-of-care -OHB and the urine dipstick are equally sensitive for detecting DKA (98.1%). However, -OHB is more specific (78.6 vs. 35.1%), offering the potential to significantly reduce unnecessa Continue reading >>

Symptoms And Detection Of Ketoacidosis

Symptoms And Detection Of Ketoacidosis

* these are more specific for ketoacidosis than hyperosmolar syndrome Everyone with diabetes needs to know how to recognize and treat ketoacidosis. Ketones travel from the blood into the urine and can be detected in the urine with ketone test strips available at any pharmacy. Ketone strips should always be kept on hand, but stored in a dry area and replaced as soon as they become outdated. Measurement of Ketones in the urine is very important for diabetics with infections or on insulin pump therapy due to the fact it gives more information than glucose tests alone. Check the urine for ketones whenever a blood sugar reading is 300 mg/dl or higher, if a fruity odor is detected in the breath, if abdominal pain is present, if nausea or vomiting is occurring, or if you are breathing rapidly and short of breath. If a moderate or large amount of ketones are detected on the test strip, ketoacidosis is present and immediate treatment is required.  Symptoms for hyperglycemic hyperosmolar syndrome are linked to dehydration rather than acidosis, so a fruity odor to the breath and stomach upset are less likely. During any illness, especially when it is severe and any time the stomach becomes upset, ketone levels should be determined. Never assume an upset stomach is due to food poisoning or the flu without determining if ketones are the cause. During any prolonged illness, ketones should be tested every 4 hours.  After ketones are formed from fat metabolism, they collect in the blood and are excreted into the urine. There are two ways to measure ketones at home: in the blood with a specialized meter, like the Precision Xtra™ , which measures both sugar and ketones in blood. This is the fastest way to tell if ketones are rising, and the best method for parents to use to quickly Continue reading >>

What You Should Know About Diabetic Ketoacidosis

What You Should Know About Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a serious condition that can occur in diabetes. DKA happens when acidic substances, called ketones, build up in your body. Ketones are formed when your body burns fat for fuel instead of sugar, or glucose. That can happen if you don’t have enough insulin in your body to help you process sugars. Learn more: Ketosis vs. ketoacidosis: What you should know » Left untreated, ketones can build up to dangerous levels. DKA can occur in people who have type 1 or type 2 diabetes, but it’s rare in people with type 2 diabetes. DKA can also develop if you are at risk for diabetes, but have not received a formal diagnosis. It can be the first sign of type 1 diabetes. DKA is a medical emergency. Call your local emergency services immediately if you think you are experiencing DKA. Symptoms of DKA can appear quickly and may include: frequent urination extreme thirst high blood sugar levels high levels of ketones in the urine nausea or vomiting abdominal pain confusion fruity-smelling breath a flushed face fatigue rapid breathing dry mouth and skin It is important to make sure you consult with your doctor if you experience any of these symptoms. If left untreated, DKA can lead to a coma or death. All people who use insulin should discuss the risk of DKA with their healthcare team, to make sure a plan is in place. If you think you are experiencing DKA, seek immediate medical help. Learn more: Blood glucose management: Checking for ketones » If you have type 1 diabetes, you should maintain a supply of home urine ketone tests. You can use these to test your ketone levels. A high ketone test result is a symptom of DKA. If you have type 1 diabetes and have a glucometer reading of over 250 milligrams per deciliter twice, you should test your urine for keton Continue reading >>

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