[IP] DKA and lab tests
I am a bit confused on the test that you are referring to. With DKA there
are several blood tests that are significantly (and critically) thrown
off. The first is obviously glucose. Second is a blood acetone test.
Acetone is a Ketone test of the blood. Normal acetone level is negative.
Most labs test this level with a dilution until they see the ketones
unreactive. They will report this as a serial dilution 1:1 (straight
serum is reactive), 1:2(1 part serum and 1 part diluent is still reactive, 1:4,
1:16 etc.... Once
the blood becomes acidotic due to the increase in ketones, we are
clinically in ketoacidosis. With acidosis, the pH of the blood is
generally less than (more acidic than) 7.25. This is more specifically
referred to as metabolic acidosis and is also a critically significant
lab result. The ER was probably measuring an indirect measurement of the
acidity of the blood which is the HCO (bicarbonate) level of the blood.
When the pH of the blood becomes acidic, the body compensates by reducing
the HCO level. Typically the a bicarbonate level is above 20. With severe
acidosis, sometimes the bicarb level will be single digits. Many nurses
are often confused with blood gas results, and it may have been confusing
for them to try to communicate these results to you. My guess is that
they were talking about three separate lab results: the acidity of the
blood (pH), the Acetone level (ketone measurement), and bicarbonate level
(indirect acidosis measurement.
Mike Oberle, MT (ASCP)
Date: Fri, 07 Nov 2003 09:38:18 -0800
From: Terra Smith <email @ redacted>
Subject: [IP] DKA is what the dx was.
DKA is what the dx was.
It finally happened. For the first time ever my 12 yr. old had to go to
the hospital. On Monday she said she didn't feel well, like she was
getting a cold. Her tests were good. She went to bed at 168. Around 12
am she woke me up and said she had thrown up. She said her bs was 86. I
thought, ok so maybe she's getting the flu. In my half wakened state I
stupidly told her to go back to bed. Well turns out she tested at 504
but thought it was from her not washing her hands. So i'm thinking when
she tested again maybe she had water on her hands. She was up all night
throwing up. For some reason she didn't come tell me. I think she
completely loses all common sense when she her bs is high. Anyway she
looked like death in the morning. Pale skin , Sunken in eyes & face. The
worst I have ever seen her. BS of HI (over 600), her pump was on &
working fine but the site was??? I don't know how many days old (she
used to change it herself). So the site was infected & the canual was
bent. I gave her a shot & changed her site. She had been sick before
last year but I nursed her back. I know I probably could have done it
again but I wanted her (This sounds bad & mean but....) to experience
going to the hospital getting A 20 gage I V , Getting labs ran a few
times & seeing how the Dr.'s & nurses reacted to her current condition.
Kind of a wake up call, saying "hey take care of yourself this is not a
game". They took her right back & started an IV. Ran labs & besides her
high bs, all her labs were good except she had an acid tone level of 10.
Normal is above 20. Does anyone have info on this?? They gave her one
more bag on the IV then redid the acid tone test. It went up to 14 so
they said she could go home. If it hadn't gone up they said they would
admit her. She also had meds for the nausea which completely knocked her
out. We were there 5 hrs. in the ER. Which I think was really good
considering how busy they normally are. Hopefully it woke her up to
reality. I'm thinking it did. She's been testing more & her bs's are
really good.......go figure.
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