What is the anion gap for DKA?
In mild DKA, anion gap is greater than 10 and in moderate or severe DKA the anion gap is greater than 12. These figures differentiate DKA from HHS where blood glucose is greater than 600 mg/dL but pH is greater than 7.3 and serum bicarbonate greater than 15 mEq/L.
Why is there anion gap in DKA?
At physiological pH, these 2 ketoacids dissociate completely, and the excess hydrogen ions bind the bicarbonate, resulting in decreased serum bicarbonate levels. Ketone bodies thus circulate in the anionic form, which leads to the development of anion gap acidosis that characterizes DKA.
Does DKA increase anion gap?
DKA is characterized by hyperglycemia, an elevated anion gap* metabolic acidosis, and ketonemia.
When is the anion gap closed in DKA?
DKA is resolved when 1) plasma glucose is <200–250 mg/dL; 2) serum bicarbonate concentration is ≥15 mEq/L; 3) venous blood pH is >7.3; and 4) anion gap is ≤12. In general, resolution of hyperglycemia, normalization of bicarbonate level, and closure of anion gap is sufficient to stop insulin infusion.
What is an anion gap?
The anion gap measures the difference—or gap—between the negatively charged and positively charged electrolytes in your blood. If the anion gap is too high, your blood is more acidic than normal. If the anion gap is too low, your blood isn’t acidic enough.
What is the clinical significance of anion gap?
The principal clinical use of the anion gap is in assessment of acid-base disturbances, particularly metabolic acidosis. Marked increase in anion gap (> 25 mmol/L) is almost invariably incontrovertible evidence of metabolic acidosis.
Is beta hydroxybutyrate specific for DKA?
A β-hydroxybutyrate level of more than 1.5 mmol/L had sensitivity ranging from 98-100% and specificity ranging from 78.6-93.3% for the diagnosis of diabetic ketoacidosis in diabetic patients presenting to the ED with blood glucose levels of more than 250mg/dL.
Can you have DKA without anion gap?
DKA patients often develop a non-anion-gap, hyperchloremic metabolic acidosis. This may occur due to gradual development of DKA with urinary excretion of ketoacid (which then cannot be converted to bicarbonate) and/or initial resuscitation with NS.
What is an anion gap in blood work?
What does anion gap 9 mean?
An anion gap number between 3 and 10 is considered normal. But the “normal” range can vary from person to person, and it may also depend on the methods your lab used to do the test.
What is an elevated anion gap?
Although there are differences between laboratories and assays, the normal anion gap has traditionally been set between 8 mEq/L to 12 mEq/L. If the anion gap is greater than 12, this suggests an increased presence of unmeasured anions.