Medicine Matters diabetes

Tests 3 and 4 were done initially. As the patient was acutely unwell it was important to do a routine screen to assess if there was infection, or electrolyte imbalance. In addition, a venous blood gas was important given his diabetes history and medication that could cause acidosis.

Test 1 was also done, once the patient recovered, to assess if he was at greater risk of ketoacidosis due to having latent autoimmune diabetes in adulthood (LADA). The result of this test came back negative.

Initial investigations

Laboratory test	Result	Normal range/Interpretation
Venous blood gas	pH: 7.055 Glucose: 12.3 mmol/L Bicarbonate: 9 mmol/L Lactate: 1.5 mmol/L	pH: 7.35–7.45 Glucose: 4.0–5.4mmol/L fasting; up to 7.8 mmol/L 2 hours post meal Bicarbonate: 22–26mmol/L Lactate: <2.0mmol/L
Urinalysis	Ketones: 4+ Glucose: 4+ Protein: neg	Ketones: neg Glucose: neg Protein: neg
Bloods	Sodium: 132 mmol/L Potassium: 5.4 mmol/L Urea: 5.9 mmol/L Chloride: 105 mmol/L White blood cell count: 12.4 × 10⁹/L Hemoglobin: 179 g/L HbA1c: 90 mmol/mol (10.4%)	Sodium: 134–146 mmol/L Potassium: 3.4–5.2 mmol/L Urea: 3.2–7.6 mmol/L Chloride: 98–106 mmol/L White blood cell count: 4.0–11.0 × 10⁹/L Hemoglobin: 115–165 g/L HbA1c: 20–42mmol/mol (4.0–6.0%)
Electrocardiogram	Sinus tachycardia, nil acute	–

HbA1c=Glycated hemoglobin

Physical exam

Acutely ill, appears dehydrated and has Kussmaul breathing*
Body mass index:29 kg/m²
Blood pressure: 138/78 mmHg
Pulse: 113 beats per minute
Respiratory rate: 26 breaths per minute
Temperature: 37°C

^*Deep and labored breathing

Medicine Matters Diabetes

Medicine Matters diabetes

Initial investigations