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Fda Issues Safety Statement That Sglt-2 Inhibitors May Cause Diabetic Ketoacidosis

Fda Issues Safety Statement That Sglt-2 Inhibitors May Cause Diabetic Ketoacidosis

Twitter Summary: @US_FDA warns SGLT-2 inhibitors may cause DKA in some patients w/out #hyperglycemia. Get the inside scoop from Dr. Anne Peters. Essential news for patients, caregivers, and health care providers: the FDA recently issued a drug safety warning on the possibility of diabetic ketoacidosis (DKA) in all people taking SGLT-2 inhibitor pills. Diabetic ketoacidosis is a complication of diabetes that occurs when the body produces elevated levels of acidic compounds called ketones, often due to a lack of effective insulin action, which can lead to hospitalization, coma, and even death if left untreated. Typically, diabetic ketoacidosis is associated with extremely high blood glucose levels (hyperglycemia), but the reports of diabetic ketoacidosis associated with SGLT-2 inhibitors come without these elevations in blood glucose – this is called “euglycemic diabetic ketoacidosis” or “euDKA.” It is considered an acute complication of type 1 diabetes and does not generally occur in people with type 2 diabetes. The FDA’s safety warning is currently based on 20 reported cases of euglycemic ketoacidosis when using SGLT-2 inhibitors in people who had mostly been diagnosed with type 2 diabetes, although some (using the drug off-label) were diagnosed with type 1 diabetes. As we understand it, the risk of euDKA is rare with these drugs, but when it occurs it is quite serious. Part of the problem is that euDKA can often be misdiagnosed when health care providers aren’t aware of the need to check for elevated ketone levels in the absence of hyperglycemia, or when someone is diagnosed with type 2 diabetes. If diagnosed correctly, though, the treatment for euDKA is relatively simple and primarily requires the administrations of intravenous (IV) insulin, fluids, and Continue reading >>

Get Unlimited Access On Medscape.

Get Unlimited Access On Medscape.

You’ve become the New York Times and the Wall Street Journal of medicine. A must-read every morning. ” Continue reading >>

Europe Agrees: Learn The Signs Of Atypical Dka In Patients Using Sglt-2s

Europe Agrees: Learn The Signs Of Atypical Dka In Patients Using Sglt-2s

European committee affirms benefits of SGLT-2s while urging healthcare providers to be vigilant and educate patients for signs and symptoms of atypical DKA. The FDA issued a warning back in 2015 about the risk of developing atypical diabetic ketoacidosis (DKA) in patients taking SGLT-2 inhibitors. Now, the European Commission has stepped in, as it has requested to have this class of medications reviewed by Pharmacovigilance Risk Assessment Committee (PRAC). PRAC is a European committee responsible for the safety of human medicine and makes recommendations for providing harmless and effective healthcare in Europe. In February of 2016, PRAC issued a review of sodium-glucose cotransporter 2 inhibitors, commonly known as SGLT-2 inhibitors. PRAC warns healthcare professionals about cases of DKA in patients who are on SGLT-2 inhibitor therapy. Patients could experience symptoms of DKA, but their glucose level might not be as high as usually seen in DKA, which would cause a delay in appropriate treatment of this life-threatening condition. However, PRAC did not state what would be the number that would indicate a possible case of atypical DKA. SGLT-2 inhibitors are approved only for type 2 diabetes patients. They have a unique mechanism of action, as they affect receptors in kidneys. They inhibit the sodium-glucose cotransporter 2 in the proximal tubules and reduce reabsorption of filtered glucose from the tubular lumen and lower the renal threshold for glucose. As a result, more glucose is excreted in the urine and patients have lower glucose concentrations in their bloodstream. SGLT-2 inhibitors are popular among people with diabetes because they are pill form rather than injections, and they lower A1C level by 0.7% to 1.0%, as well as helping patients to lose weight. Curren Continue reading >>

Jardiance, Invokana, Farxiga, And The Other Sglt2 Inhibitors Might Double The Risk Of Diabetic Ketoacidosis (dka) - Drug Injury Watch

Jardiance, Invokana, Farxiga, And The Other Sglt2 Inhibitors Might Double The Risk Of Diabetic Ketoacidosis (dka) - Drug Injury Watch

Jardiance, Invokana, Farxiga, And The Other SGLT2 Inhibitors Might Double The Risk Of Diabetic Ketoacidosis (DKA) Study Compared Newly Initiated Use Of SGLT2 Inhibitor To New Initiation Of Another Class Of Diabetes Drugs To Assess The DKA Side Effect (Posted by Tom Lamb at DrugInjuryWatch.com ) All of these newer diabetes medicines are part of the Sodium-Glucose Co-Transporter-2 (SGLT2) Inhibitors class of drugs: Invokamet XR (canagliflozin and metformin extended-release) Xigduo XR (dapagliflozin and metformin extended-release) Synjardy (empagliflozin and metformin hydrochloride) Synjardy XR (empagliflozin and metformin hydrochloride) The SGLT2 inhibitor class of diabetes drugs is approved by the FDA for treatment of type 2 diabetes (T2D). A "To the Editor" letter in the June 8, 2017 edition of The New England Journal of Medicine (NEJM), titled " Risk of Diabetic Ketoacidosis after Initiation of an SGLT2 Inhibitor ",is likely causing some concerns among doctors and patients about the safety of Jardiance, Invokana, Farxiga, and the other SGLT2 inhibitors. From the start of that letter we get some introductory information about this drug-safety concern raised for these newer diabetes drugs: Inhibitors of sodiumglucose cotransporter 2 (SGLT2) decrease plasma glucose by blocking the reabsorption of glucose at the proximal tubule. Case reports have suggested that SGLT2 inhibitors may be associated with an increased risk of diabetic ketoacidosis, which led to a warning from the Food and Drug Administration (FDA) in May 2015. The objective of our study was to assess the risk of diabetic ketoacidosis after the initiation of an SGLT2 inhibitor. [footnotes omitted] A June 7, 2017 MedPage Today article, " Study Warns of Diabetic Ketoacidosis With SGLT2 Inhibitors in T2D ",provide Continue reading >>

Jardiance Lawsuits: Kidney Failure & Diabetic Ketoacidosis

Jardiance Lawsuits: Kidney Failure & Diabetic Ketoacidosis

Jardiance Lawsuits: Kidney Failure & Diabetic Ketoacidosis Commonly asked questions about Jardiance (empagliflozin): What makes me eligible for a Jardiance lawsuit? Jardiance (empagliflozin) is a drug of the gliflozin class used to treat Type 2 diabetes . It was developed by Boehringer Ingelheim. The U.S. Food and Drug Administration approved dapagliflozin in 2014 for glycemic control, along with diet and exercise, in adults with Type 2 diabetes . Common side effects of Jardiance may include: Are There Any Jardiance Lawsuits or Recalls? As Jardiance is a new drug, there are no recalls or lawsuits yet. However, The U.S. Food and Drug Administration (FDA) is warning that the type 2 diabetes medicines, which include Jardiance, may lead to ketoacidosis, a serious condition where the body produces high levels of blood acids called ketones that may require hospitalization. The FDA says that patients should pay close attention for any signs of ketoacidosis and seek medical attention immediately if they experience symptoms such as difficulty breathing, nausea, vomiting, abdominal pain, confusion, and unusual fatigue or sleepiness. Jardiance is an SGLT2 inhibitor , which is a class of prescription medicines for use with diet and exercise to lower blood sugar in adults with type 2 diabetes. SGLT2 inhibitors lower blood sugar by causing the kidneys to remove sugar from the body through the urine. What Makes Me Eligible for an Jardiance Lawsuit? The manufacturers of SGLT2 Inhibitors have been the subject of litigation because of the side effects caused by their drugs. The national Invokana lawsuit alleges that the manufacturers and marketers of SGLT2 Inhibitors failed to warn patients and physicians of the increased risks of kidney failure, myocardial infarction (heart attacks), o Continue reading >>

Sglt2 Inhibitors And Diabetic Ketoacidosis: What's Behind The Fda Warning

Sglt2 Inhibitors And Diabetic Ketoacidosis: What's Behind The Fda Warning

With commentary by Yehuda Handelsman, MD, FACP, FACE, FNLA, an endocrinologist in private practice in Tarzana, CA, Medical Director and Principal Investigator of the Metabolic Institute of America and President of the American College of Endocrinology People with diabetes who take blood sugar-lowering drugs called SGLT2 inhibitors were recently warned by the U.S. Food and Drug Administration (FDA) that they should watch for signs of a life-threatening condition called diabetic ketoacidosis. canagliflozin (Invokana) dapagliflozin (Farxiga) empagliflozin (Jardiance) as well as the combination pills: canagliflozin plus metformin (Invokamet) dapagliflozin plus metformin extended-release (Xigduo XR) empagliflozin plus linagliptin (Glyxambi). “Diabetic ketoacidosis (DKA) can be deadly,” says Amy Hess-Fischl, MS, RD, LDN, BC-ADM, CDE, an advanced practice dietitian at the University of Chicago Kovler Diabetes Center and a member of EndocrineWeb’s advisory board. “DKA is usually more of a concern for people with type 1 diabetes, but this warning is for people with type 2 diabetes who are taking the SGLT2 inhibitors, as well as people with type 1 diabetes who take these medications off label. DKA — dangerously high acid levels in the bloodstream — happens when your body breaks down fat instead of glucose for energy, releasing acidic compounds called ketones. Early symptoms include thirst, frequent urination and sweet, fruity breath, Hess-Fischl says. You may feel tired and confused, and develop nausea, stomach pain, vomiting and difficulty breathing. “If you notice symptoms, call your doctor immediately. But if you’re vomiting, can’t catch your breath or are concerned, go to the emergency room,” she says. Putting the Risk in Perspective The FDA warning, relea Continue reading >>

Farxiga, Xigduo Xr, Glyxambi, And Jardiance Lawsuits

Farxiga, Xigduo Xr, Glyxambi, And Jardiance Lawsuits

Adults with Type 2 diabetes rely on prescription drugs like Farxiga (or its extended release counterpart, Xigduo XR), Glyxambi, and Jardiance to help lower their blood sugar, but some are reporting that theyve suffered serious injuries after taking the medications. Our attorneys at Morgan & Morgan are investigating claims that these drugs could cause serious kidney problems, diabetic coma, and even death, in some patients. If Farxiga, Xigduo XR, Glyxambi, or Jardiance injured you or a loved one, contact us today for a free case evaluation. Its of no risk to you: You dont pay a thing unless we win your case. About Farxiga, Xigduo XR, Glyxambi, or Jardiance The drugs are all similar they are each classified as a sodium-glucose cotransporter 2 inhibitor (or SGLT2 inhibitor), which is a type of drug used to help lower blood sugar in patients suffering from Type 2 diabetes. Specific information about each of them is below. Farxiga (dapagliflozin) is manufactured by Bristol-Myers Squibb and AstraZeneca, and was approved by the U.S. Food and Drug Administration in 2014. That same year, the FDA approved Xigduo XR, a combination of dapagliflozin and metformin hydrochloride that is an extended-release version of Farxiga. Glyxambi is manufactured by Boehringer Ingelheim Pharmaceuticals, Inc. and Eli Lilly and Co. It combines two commonly prescribed diabetes drugs, empagliflozin (Jardiance) and linagliptin (Tradjenta). In 2015, the FDA approved Glyxambi, and at the time of its launch it was heralded as a better way to lower blood-sugar levels than either of the two contributing drugs on their own. As a solo drug Jardiance, the Boehringer medication, earned FDA approval in July 2014. Although the drugs initially approved treatment was lowering blood pressure in Type 2 diabetes suff Continue reading >>

Understanding Sglt2 Inhibitors' Diabetic Ketoacidosis Risk

Understanding Sglt2 Inhibitors' Diabetic Ketoacidosis Risk

Understanding SGLT2 Inhibitors' Diabetic Ketoacidosis Risk This article was collaboratively written withShannon Anthony, PharmD Candidate. In May 2015, the FDA issued a warning about the risk of developing diabetic ketoacidosis while using SGLT2 inhibitors. That December, the FDA updated the drugs labels to include warnings about developing ketoacidosis even with near-normal blood glucose levels.1 SGLT2 inhibitors lower blood glucose levels by decreasing renal glucose reabsorption, which increases urinary glucose excretion.2Three drugs in this class are currently available in the United States: canagliflozin (Invokana), dapagliflozin (Farxiga), and empagliflozin (Jardiance).1 These medications are approved for managing type 2 diabetes, although theyre increasingly used off-label to treat type 1 diabetes (T1D), and trials are currently being conducted to evaluate their efficacy for this potential indication.3 Diabetic ketoacidosis (DKA) develops most frequently in T1D patients secondary to omission or decreased dosage of insulin, acute illness, or a recent surgical procedure.4The typical clinical presentation includes hyperglycemia (>250mg/dL), anion-gap acidosis, and elevated plasma and urine ketones.3 Early diagnosis and management of ketoacidosis is vital. The cornerstone DKA treatment is fluid replacement, insulin therapy, and correction of electrolyte imbalances.4 In the DKA cases reported with SGLT2 inhibitors, patients had an atypical presentation of DKA resulting in delayed diagnosis and treatment. Patients presented euglycemic or with only slightly elevated blood glucose levels.1,3,5 An analysis of 9 patients who experienced an episode of DKA while on an SGLT2 inhibitor showed their range of blood glucose levels upon presentation was 96 to 224 mg/dL.3Based on t Continue reading >>

Fda Drug Safety Communication: Fda Revises Labels Of Sglt2 Inhibitors For Diabetes To Include Warnings About Too Much Acid In The Blood And Serious Urinary Tract Infections

Fda Drug Safety Communication: Fda Revises Labels Of Sglt2 Inhibitors For Diabetes To Include Warnings About Too Much Acid In The Blood And Serious Urinary Tract Infections

[12-4-2015] A U.S. Food and Drug Administration (FDA) safety review has resulted in adding warnings to the labels of a specific class of type 2 diabetes medicines called sodium-glucose cotransporter-2 (SGLT2) inhibitors about the risks of too much acid in the blood and of serious urinary tract infections. Both conditions can result in hospitalization. Patients should stop taking their SGLT2 inhibitor and seek medical attention immediately if they have any symptoms of ketoacidosis, a serious condition in which the body produces high levels of blood acids called ketones. Symptoms of ketoacidosis include nausea, vomiting, abdominal pain, tiredness, and trouble breathing. Patients should also be alert for signs and symptoms of a urinary tract infection, such as a feeling of burning when urinating or the need to urinate often or right away; pain in the lower part of the stomach area or pelvis; fever; or blood in the urine. Contact a health care professional if you experience any of these symptoms. Health care professionals should assess for ketoacidosis and urinary tract infections in patients taking SGLT2 inhibitors who present with suggestive symptoms. Ketoacidosis associated with the use of SGLT2 inhibitors can occur even if the blood sugar level is not very high. If ketoacidosis is suspected, the SGLT2 inhibitor should be discontinued and treatment instituted promptly. SGLT2 inhibitors are a class of prescription medicines that are FDA-approved for use with diet and exercise to lower blood sugar in adults with type 2 diabetes. When untreated, type 2 diabetes can lead to serious problems, including blindness, nerve and kidney damage, and heart disease. Medicines in the SGLT2 inhibitor class include canagliflozin, dapagliflozin, and empagliflozin (see section on List of FD Continue reading >>

Will You Have Dka With Jardiance - From Fda Reports - Ehealthme

Will You Have Dka With Jardiance - From Fda Reports - Ehealthme

A study for a 48 year old woman who takes Botox NOTE: The study is based on active ingredients and brand name. Other drugs that have the same active ingredients (e.g. generic drugs) are NOT considered. WARNING: Please DO NOT STOP MEDICATIONS without first consulting a physician since doing so could be hazardous to your health. DISCLAIMER: All material available on eHealthMe.com is for informational purposes only, and is not a substitute for medical advice, diagnosis, or treatment provided by a qualified healthcare provider. All information is observation-only, and has not been supported by scientific studies or clinical trials unless otherwise stated. Different individuals may respond to medication in different ways. Every effort has been made to ensure that all information is accurate, up-to-date, and complete, but no guarantee is made to that effect. The use of the eHealthMe site and its content is at your own risk. You may report adverse side effects to the FDA at or 1-800-FDA-1088 (1-800-332-1088). If you use this eHealthMe study on publication, please acknowledge it with a citation: study title, URL, accessed date. Continue reading >>

Jardiance, Invokana, And Farxiga Double Risk Of Diabetic Ketoacidosis

Jardiance, Invokana, And Farxiga Double Risk Of Diabetic Ketoacidosis

Jardiance, Invokana, And Farxiga Double Risk Of Diabetic Ketoacidosis The June 8, 2017 edition of The New England Journal of Medicine (NEJM) has a To the Editor letter, titled Risk of Diabetic Ketoacidosis after Initiation of an SGLT2 Inhibitor, which is likely causing some concerns among doctors and type 2 diabetes (T2D) patients. It is about the safety of Jardiance, Invokana, Farxiga, and other diabetes medicines in the SGLT2 inhibitor class of diabetes drugs. A June 7, 2017 MedPage Today article, Study Warns of Diabetic Ketoacidosis With SGLT2 Inhibitors in T2D, provides a summary and some commentary about the recent medical study which is described in this June 2017 NEJM letter to the editor: The newest class of drugs for treating type 2 diabetes carries a greater risk for diabetic ketoacidosis compared to other classes of drugs, a new study suggests. Newly initiated use of an SGLT2 inhibitor was associated with a roughly twofold greater risk of diabetic ketoacidosis versus new initiation of a DPP4 inhibitor (HR 2.2, 95% CI 1.4 to 3.6), according to Michael Fralick, MD, of Brigham and Womens Hospital, and colleagues. It is important to know that if diabetic ketoacidosis (DKA) is not treated, it can lead to severe illness or death. In more detail, possible complications of DKA include these medical conditions: Cerebral Edema (fluid buildup in the brain) Bowel Necrosis (death of bowel tissue due to low blood pressure) All of these newer diabetes medicines are part of the Sodium-Glucose Co-Transporter-2 (SGLT2) Inhibitors class of drugs: Invokamet XR (canagliflozin and metformin extended-release) Xigduo XR (dapagliflozin and metformin extended-release) Continue reading >>

Three Diabetes Drugs Linked To Ketoacidosis, Fda Warns

Three Diabetes Drugs Linked To Ketoacidosis, Fda Warns

NASHVILLE -- Three type 2 diabetes drugs -- canagliflozin (Invokana), dapagliflozin (Farxiga), and empagliflozin (Jardiance) -- may lead to ketoacidosis, the FDA warned today. The sodium-glucose co-transporter-2 (SGLT2) inhibitors are designed to lower blood sugar in patients with diabetes, but the FDA is investigating a connection between the drugs and dangerously high acid levels in the blood. They are also looking at whether changes will need to be made to the prescribing information, they said in the warning, which is posted online. At least two studies presented here at the annual meeting of the American Association of Clinical Endocrinologists have found a connection between the SGLT2 inhibitors and diabetic ketoacidosis (DKA). "Healthcare professionals should evaluate for the presence of acidosis, including ketoacidosis, in patients experiencing these signs or symptoms," the FDA said. "Discontinue SGLT2 inhibitors if acidosis is confirmed, and take appropriate measures to correct the acidosis and monitor sugar levels." The signs and symptoms listed included difficulty breathing, nausea, vomiting, abdominal pain, confusion, and unusual fatigue or sleepiness. The FDA is issuing the warning after they searched their database of adverse event complaints, they said in an announcement. From March 2013 to June 2014 there were 20 cases of DKA reported, most of them with type 2 diabetes as the indication. Hospitalization was required in all of the cases, and the median time to onset was 2 weeks after starting the drug. "I would encourage that these cases be studied so we can learn the scenarios behind them so they can be broadcast," said Farhad Zangeneh, MD, medical director of Endocrine, Diabetes and Osteoporosis Clinic, in an interview with MedPage Today. "The important Continue reading >>

Diabetes Drugs Linked To Higher Risk For Rare But Deadly Complication

Diabetes Drugs Linked To Higher Risk For Rare But Deadly Complication

A new class of type 2 diabetes drugs called SGLT2 inhibitors could increase the risk of a rare, life-threatening complication of the disease called ketoacidosis, a new study warns. SGLT2 inhibitors include prescription medications such as canagliflozin, dapagliflozin and empagliflozin. Brand names are Invokana, Invokamet, Farxiga, Xigduo XR, Jardiance and Glyxambi. These drugs first became available in 2013, but in 2015 the U.S. Food and Drug Administration issued a warning about an increased risk for diabetic ketoacidosis when SGLT2 inhibitors are used. The condition typically occurs in people with type 1 diabetes. And while it is uncommon in people with type 2 diabetes, case reports have shown it can occur with type 2 disease, according to the study authors. Ketoacidosis can cause vomiting, abdominal pain, shortness of breath and swelling in the brain. Left untreated, the condition can be fatal, the researchers said. The new study "essentially confirms what doctors had already suspected," said diabetes expert Dr. Stanislaw Klek, an endocrinologist at NYU Winthrop Hospital in Mineola, N.Y. "Fortunately, the rate of diabetic ketoacidosis is still very low and should not prevent the usage of this medication class," he added. "It is important to be aware of this potential complication and monitor for symptoms of diabetic ketoacidosis, particularly during periods of illness." In the new study, researchers at Brigham and Women's Hospital in Boston analyzed data from 40,000 people with type 2 diabetes. They found that those taking SGLT2 inhibitors were twice as likely to develop diabetic ketoacidosis than those taking another class of diabetes drugs called DPP4 inhibitors (drugs such as Januvia and Onglyza). Still, the risk to any one patient remains very slim, the researche Continue reading >>

Jardiance Ketoacidosis Is Potential Risk Of Popular Diabetes Drug

Jardiance Ketoacidosis Is Potential Risk Of Popular Diabetes Drug

Jardiance Ketoacidosis is Potential Risk of Popular Diabetes Drug The diabetes drug Jardiance has been linked with a number of serious complications, including an increased risk of Jardiance ketoacidosis. Jardiance (also known by its generic name, empagliflozin) is a diabetes drug jointly manufactured by Eli Lilly and Boehringer Ingelheim Pharmaceuticals. The diabetes medication, along with other diabetes drugs belonging to its class, has recently been accused of increasing a patients risk of developing Jardiance ketoacidosis . Jardiance, Invokana, and Farxiga are all members of a new class of diabetes medications approved to treat type-2 diabetes. These drugs are known as sodium-glucose cotransporter-2 (SGLT2) inhibitors. SGLT2 inhibitors include the following diabetes drugs: Unfortunately, despite the popularity of SGLT2 inhibitor drugs like Jardiance, these medications have been linked with ketoacidosis complications. In response to reports of Jardiance ketoacidosis and ketoacidosis associated with other SGLT2 inhibitor drugs, the U.S. Food and Drug Administration (FDA) has issued a warning for drugs in the SGLT2 inhibitor class. Jardiance ketoacidosis can be a serious complication. Essentially, ketoacidosis is the buildup of high levels of ketones, or blood acids, in the blood. This can lead to a number of symptoms, including the following: In the drugs first fifteen months on the market, the FDA reports having received over twenty adverse events reports linking SGLT2 inhibitors like Jardiance with ketoacidosis problems. These patients required emergency room treatment and/or hospitalization due to diabetic ketoacidosis, ketosis, acidosis, or other similar conditions. Diabetic ketoacidosis is generally associated with type-1 diabetes. Type-1 diabetes is a condition Continue reading >>

Euglycemic Diabetic Ketoacidosis In Type 2 Diabetes Treated With A Sodium-glucose Cotransporter-2 Inhibitor

Euglycemic Diabetic Ketoacidosis In Type 2 Diabetes Treated With A Sodium-glucose Cotransporter-2 Inhibitor

Go to: Case A 51-year-old man with a known history of T2DM and hypertension presented to the emergency department with a 1-week history of malaise, cough, and intermittent shortness of breath. Over the preceding 2 days, he admitted to a history of decreased oral intake and fever, and he had abstained from taking his antihyperglycemic medications (canagliflozin and linagliptin-metformin). He reported 3 episodes of clear emesis the day of his presentation in the emergency department. He denied any other symptoms, sick contacts, or travel history. He reported no substance use, alcohol consumption, or other ingestions. He was not vaccinated against the flu. He was not taking insulin. Vital signs at triage were within normal limits except for a heart rate of 122 beats/min. The patient looked well and was in no acute distress. The only relevant physical examination findings were mild inspiratory crackles at the left lower lobe on auscultation of the lungs. A 12-lead electrocardiogram showed sinus tachycardia at 101 beats/min. Initial bloodwork revealed a hemoglobin level of 159 g/L (normal range 130 to 170 g/L); a white blood cell count of 12.1 × 109/L (normal range 4.8 × 109/L to 10.8 × 109/L); a neutrophil count of 11.0 × 109/L (normal range 2.0 × 109/L to 7.0 × 109/L); a platelet count of 405 × 109/L (normal range 130 × 109/L to 400 × 109/L); a random blood glucose level of 11.9 mmol/L (normal range 3.9 to 11.2 mmol/L); a sodium concentration of 139 mmol/L (normal range 136 to 144 mmol/L); a potassium level of 5.0 mmol/L (normal range 3.5 to 5.5 mmol/L); a chloride level of 93 mmol/L (normal range 98 to 109 mmol/L); a total CO2 level of 8 mmol/L (normal range 22 to 29 mmol/L); an anion gap of 38 mmol/L (normal range 4 to 12 mmol/L); a urea level of 9.3 mmol/L (nor Continue reading >>

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