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pseudohyponatremia in dka


Gaboury I, In one study, persons with DKA had symptoms of diabetes for 24.5 days before developing DKA.17 Persons with diabetes and their caregivers should be familiar with adjusting insulin during times of illness. Copyright © 2013 by the American Academy of Family Physicians. Yadav D, Gearoid McMahon, MB, BCh, Click here for bios of RFN Editorial Board, Focus on POCUN (Point of Care Ultrasound in Nephrology).

44. Newton M, Menchine et al evaluated the accuracy of blood gas vs biochemistry testing in Emergency Room patients presenting with diabetic ketoacidosis (DKA). Persons known to have diabetes can be started on their outpatient dose, with adjustments to improve control.

Copyright 2006 American Diabetes Association. Sign up for the free AFP email table of contents. St George-Hyslop C, Umpierrez GE,


Moltz K, 2010;33(suppl 1):S89–S96. 34.

27. Westphal SA.

3rd ed. DKA is the initial manifestation of diabetes in 20% of adult patients1 and 30–40% of children15,16 with type 1 diabetes. Fam Med.

2010;156(1):109–114. Contact Balasubramanyam A, The percentage of plasma in whole blood is calculated by 1-hct. Diabetic ketoacidosis at diagnosis in Austrian children in 1989–2008: a population-based analysis. Curr Diab Rep. Antipsychotic agents: clozapine (Clozaril),10 olanzapine (Zyprexa),11 risperidone (Risperdal)12, Others: corticosteroids, glucagon, interferon,14 pentamidine,14 sympathomimetic agents,14 thiazide diuretics4, Pneumonia, sepsis, urinary tract infection, Nonadherence to insulin treatment plans: body image issues,15 financial problems, psychological factors, Unrecognized symptoms of new-onset diabetes mellitus, Acromegaly,14 arterial thrombosis,14 cerebrovascular accident, Cushing disease,16 hemochromatosis,14 myocardial infarction, pancreatitis,14 pregnancy,14 psychological stress,16 shock/hypovolemia, trauma16.

Diabetic ketoacidosis. Brooks WG, Pseudohyponatremia Revisited A Modern-Day Pitfall Philip Fortgens, MB, PhD; Tahir S. Pillay, MB, PhD, FRCPath(UK) N Factitiously low sodium estimations are a hazard in most modern clinical laboratories.

Sari R,

American Diabetes Association. Diabetic ketoacidosis. Bektas F, Kim HE.

‘Diabulimia’ a growing problem among diabetic girls Nephrol News Issues. For persons younger than 20 years, insulin should be administered gradually, and fluid and electrolyte replacement should be done cautiously because of limited data and concern for precipitating cerebral edema. Li LX, 45.
Nephrology Fellow As I began to look through the chart, I noticed something startling. Pitchumoni CS. In the patient with hyperglycemia induced hyponatremia glucose can be a large component of osmolarity. Guerguerian AM, Diabetic ketoacidosis Ann Intern Med. Karas J. HHS occurs frequently in elderly or debilitated patients who do not recognize or cannot treat the symptoms of diabetes and dehydration or, in many cases, who have caregivers who are not knowledgeable about the signs and symptoms of diabetes and the conditions, procedures, and medications that can lead to decompensation. Many patients with hyperglycemic crises who experience hypoglycemia during treatment do not experience adrenergic manifestations of sweating, nervousness, fatigue, hunger, and tachycardia despite low blood glucose levels (GEU, unpublished observations). Katz MA. Improved renal perfusion will increase excretion. Diabetes Care. Smith RB. If the potassium level is in the normal range, replacement can start at 10 to 15 mEq potassium per hour. J Pediatr. The treatment goal is to maintain serum potassium levels within the normal range of 4–5 mEq/L. Patients with chronic ethanol abuse with a recent binge culminating in nausea, vomiting, and acute starvation may present with alcoholic ketoacidosis. Although hyperosmolar hyperglycemic state can be confused with DKA, ketone levels are low or absent in persons with hyperosmolar hyperglycemic state. Lee SH, Although persons with DKA usually have a glucose level greater than 250 mg per dL, a few case reports document DKA in pregnant women who were euglycemic.20,21  Persons with hyperglycemia have pseudohyponatremia, and serum sodium concentration should be corrected. 2010;16(3):358–363. Funnell MM, Brown TL, Childs BP, et al. Venous pH may be measured as an alternative to arterial pH in persons with DKA who are hemodynamically stable and withoutrespiratory failure.

An initial bolus of 0.1 units per kg should be given with an infusion of 0.1 units per kg per hour.4 Some believe this bolus is unnecessary as long as an adequate infusion of insulin is maintained.31 An infusion of 0.14 units per kg per hour is recommended in the absence of a bolus. An increase in serum sodium concentration in the presence of hyperglycemia indicates a rather profound degree of water loss. J Paediatr Child Health.

Physicians need to recognize patient barriers to getting care, such as financial, social, psychological, and cultural reasons. In Brief Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic syndrome (HHS) are two acute complications of diabetes that can result in increased morbidity and mortality if not efficiently and effectively treated. 2006;23(3):278–284. Diabetologia. 2009;32(7):1335–1343. In some patients, focal neurological signs (hemiparesis, hemianopsia) and seizures (partial motor seizures more common than generalized) may be the dominant clinical features, resulting in a common misdiagnosis of stroke.21 Despite the focal nature of neurological findings, these manifestations often reverse completely after correction of the metabolic disorder.

Yang LZ, Web-based versus face-to-face learning of diabetes management: the results of a comparative trial of educational methods. Jeremie Lever, Pediatric Nephrology Series ‘Diabulimia’ a growing problem among diabetic girls, Wilson JF. Therefore, to prevent hypokalemia, most patients require intravenous potassium during the course of DKA therapy. Enter multiple addresses on separate lines or separate them with commas. Weber C,

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