Differentiating Diabetic ketoacidosis from other diseases: Difference between revisions
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==Differentiating Diabetic Ketoacidosis From Other Diseases== | ==Differentiating Diabetic Ketoacidosis From Other Diseases== | ||
Diabetic ketoacidosis must be differentiated from other diseases causing the following conditions: | Diabetic ketoacidosis must be differentiated from other diseases causing the following conditions:<ref name="urlDiabetic Ketoacidosis: Evaluation and Treatment - American Family Physician">{{cite web |url=http://www.aafp.org/afp/2013/0301/p337.html |title=Diabetic Ketoacidosis: Evaluation and Treatment - American Family Physician |format= |work= |accessdate=}}</ref><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="pmid18975036">{{cite journal |vauthors=Joseph F, Anderson L, Goenka N, Vora J |title=Starvation-induced true diabetic euglycemic ketoacidosis in severe depression |journal=J Gen Intern Med |volume=24 |issue=1 |pages=129–31 |year=2009 |pmid=18975036 |pmc=2607495 |doi=10.1007/s11606-008-0829-0 |url=}}</ref><ref name="pmid6361416">{{cite journal |vauthors=Williams HE |title=Alcoholic hypoglycemia and ketoacidosis |journal=Med. Clin. North Am. |volume=68 |issue=1 |pages=33–8 |year=1984 |pmid=6361416 |doi= |url=}}</ref><ref name="pmid1554971">{{cite journal |vauthors=Durnas C, Cusack BJ |title=Salicylate intoxication in the elderly. Recognition and recommendations on how to prevent it |journal=Drugs Aging |volume=2 |issue=1 |pages=20–34 |year=1992 |pmid=1554971 |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=13607 |url=}}</ref><ref name="pmid9587792">{{cite journal |vauthors=Brinkmann B, Fechner G, Karger B, DuChesne A |title=Ketoacidosis and lactic acidosis--frequent causes of death in chronic alcoholics? |journal=Int. J. Legal Med. |volume=111 |issue=3 |pages=115–9 |year=1998 |pmid=9587792 |doi= |url=}}</ref> | ||
* '''<u>Other conditions causing hyperglycemia</u>''' | * '''<u>Other conditions causing hyperglycemia</u>''' | ||
** [[Diabetes mellitus]] | ** [[Diabetes mellitus]] | ||
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===Differential diagnosis of increased anion gap metabolic acidosis=== | ===Differential diagnosis of increased anion gap metabolic acidosis=== | ||
*Causes of increased anion gap metabolic acidosis can be differetiated from each other with the help of following alogrhythm: | *Causes of increased anion gap metabolic acidosis can be differetiated from each other with the help of following alogrhythm:<ref name="pmid17936961">{{cite journal |vauthors=Lim S |title=Metabolic acidosis |journal=Acta Med Indones |volume=39 |issue=3 |pages=145–50 |year=2007 |pmid=17936961 |doi= |url=}}</ref><ref name="pmid23833313">{{cite journal |vauthors=Kraut JA, Nagami GT |title=The serum anion gap in the evaluation of acid-base disorders: what are its limitations and can its effectiveness be improved? |journal=Clin J Am Soc Nephrol |volume=8 |issue=11 |pages=2018–24 |year=2013 |pmid=23833313 |pmc=3817910 |doi=10.2215/CJN.04040413 |url=}}</ref><ref name="pmid24079682">{{cite journal |vauthors=Andersen LW, Mackenhauer J, Roberts JC, Berg KM, Cocchi MN, Donnino MW |title=Etiology and therapeutic approach to elevated lactate levels |journal=Mayo Clin. Proc. |volume=88 |issue=10 |pages=1127–40 |year=2013 |pmid=24079682 |pmc=3975915 |doi=10.1016/j.mayocp.2013.06.012 |url=}}</ref><ref name="pmid1638782">{{cite journal |vauthors=Abuelo JG, Shemin D, Chazan JA |title=Serum creatinine concentration at the onset of uremia: higher levels in black males |journal=Clin. Nephrol. |volume=37 |issue=6 |pages=303–7 |year=1992 |pmid=1638782 |doi= |url=}}</ref><ref name="pmid3054224">{{cite journal |vauthors=Warnock DG |title=Uremic acidosis |journal=Kidney Int. |volume=34 |issue=2 |pages=278–87 |year=1988 |pmid=3054224 |doi= |url=}}</ref> | ||
{{familytree/start}}{{familytree | | | | | | | | | A01 | | | | | |A01=↑ anion gap metabolic acidosis}} | {{familytree/start}}{{familytree | | | | | | | | | A01 | | | | | |A01=↑ anion gap metabolic acidosis}} | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [2]
Overview
Diabetic ketoacidosis (DKA) must be differentiated from other conditions presenting with hyperglycemia, ketosis and metabolic acidosis. The differentials include diabetes mellitus, non-ketotic hyperosmolar state, impaired glucose tolerance, ketotic hypoglycemia, alcoholic ketosis, starvation ketosis, lactic acidosis, salicylic acid ingestion, uremic acidosis and drug-induced acidosis. All these conditions may be differentiated on the basis of history findings, clinical features and laboratory abnormalities.
Differentiating Diabetic Ketoacidosis From Other Diseases
Diabetic ketoacidosis must be differentiated from other diseases causing the following conditions:[1][2][3][4][5][6][7][8]
- Other conditions causing hyperglycemia
- Other conditions causing ketosis
- Ketotic hypoglycemia
- Alcoholic ketosis
- Starvation ketosis
- Other conditions causing metabolic acidosis
- Lactic acidosis
- Salicylic acid ingestion
- Uremic acidosis
- Drug-induced acidosis
| Characteristic Common to DKA | Condition | History Findings | Clinical Features | Lab abnormalities |
|---|---|---|---|---|
| Hyperglycemia | Diabetes mellitus |
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| Non-ketotic hyperosmolar state |
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| Impaired glucose tolerance |
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| Ketosis | Alcoholic ketosis |
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| Starvation ketosis |
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| Metabolic acidosis | Lactic acidosis |
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| Salicylic acid ingestion |
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| Uremic acidosis |
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| Drug-induced acidosis |
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Differential diagnosis of increased anion gap metabolic acidosis
- Causes of increased anion gap metabolic acidosis can be differetiated from each other with the help of following alogrhythm:[9][10][11][12][13]
| ↑ anion gap metabolic acidosis | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| ↑ Lactate | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Yes | No | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Lactic acidosis | Check for hyperglycemia and ketonuria | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Present | Not Present | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Diabetic ketoacidosis | ↑ BUN, ↑ creatinine and history of hemodyalysis | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Yes | No | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Uremic acidosis | Physical findings include odor of alcohol | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Yes | No | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| ↑ Ethanol level in serum or expired air | Auditory symptoms present | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Ethanol overdose | Salicylic acid overdose | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
References
- ↑ "Diabetic Ketoacidosis: Evaluation and Treatment - American Family Physician".
- ↑ 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.
- ↑ Joseph F, Anderson L, Goenka N, Vora J (2009). "Starvation-induced true diabetic euglycemic ketoacidosis in severe depression". J Gen Intern Med. 24 (1): 129–31. doi:10.1007/s11606-008-0829-0. PMC 2607495. PMID 18975036.
- ↑ Williams HE (1984). "Alcoholic hypoglycemia and ketoacidosis". Med. Clin. North Am. 68 (1): 33–8. PMID 6361416.
- ↑ Durnas C, Cusack BJ (1992). "Salicylate intoxication in the elderly. Recognition and recommendations on how to prevent it". Drugs Aging. 2 (1): 20–34. PMID 1554971.
- ↑ 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:13607 Check
|doi=value (help). PMID 10970986. - ↑ Brinkmann B, Fechner G, Karger B, DuChesne A (1998). "Ketoacidosis and lactic acidosis--frequent causes of death in chronic alcoholics?". Int. J. Legal Med. 111 (3): 115–9. PMID 9587792.
- ↑ Lim S (2007). "Metabolic acidosis". Acta Med Indones. 39 (3): 145–50. PMID 17936961.
- ↑ Kraut JA, Nagami GT (2013). "The serum anion gap in the evaluation of acid-base disorders: what are its limitations and can its effectiveness be improved?". Clin J Am Soc Nephrol. 8 (11): 2018–24. doi:10.2215/CJN.04040413. PMC 3817910. PMID 23833313.
- ↑ Andersen LW, Mackenhauer J, Roberts JC, Berg KM, Cocchi MN, Donnino MW (2013). "Etiology and therapeutic approach to elevated lactate levels". Mayo Clin. Proc. 88 (10): 1127–40. doi:10.1016/j.mayocp.2013.06.012. PMC 3975915. PMID 24079682.
- ↑ Abuelo JG, Shemin D, Chazan JA (1992). "Serum creatinine concentration at the onset of uremia: higher levels in black males". Clin. Nephrol. 37 (6): 303–7. PMID 1638782.
- ↑ Warnock DG (1988). "Uremic acidosis". Kidney Int. 34 (2): 278–87. PMID 3054224.