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Excess osmolal gap in diabetic ketoacidosis explained
1Biochemistry Department, Crosshouse Hospital, Kilmarnock, Scotland, U.K.
Clinical Chemistry
|May 1, 1992
Summary
Diabetic ketoacidosis often shows a large plasma osmolal gap due to acetone and reduced plasma water. Treatment rapidly resolves this gap, clarifying metabolic anomalies.
Area of Science:
- Biochemistry
- Endocrinology
- Internal Medicine
Background:
- Diabetic ketoacidosis (DKA) is a serious complication of diabetes.
- A significant plasma osmolal gap is common in DKA, even without ethanol or lipemia.
- The composition of this gap has not been fully elucidated.
Purpose of the Study:
- To investigate the biochemical components contributing to the plasma osmolal gap in diabetic ketoacidosis.
- To understand the changes in plasma osmolality during DKA treatment.
Main Methods:
- Detailed biochemical analysis of plasma samples from six DKA patients.
- Measurement of osmolality, acetone, plasma water fraction, amino acids, and glycerol.
- Assessment of gap changes over 20 hours of treatment.
Main Results:
- The plasma osmolal gap in DKA was primarily attributed to increased acetone levels.
- A decreased plasma water fraction also significantly contributed to the osmolal gap.
- Smaller increases in amino acids and glycerol were observed.
- The osmolal gap resolved significantly within 20 hours of treatment.
Conclusions:
- Acetone accumulation and reduced plasma water are key contributors to the osmolal gap in DKA.
- Calculated plasma osmolality can underestimate true osmolality in DKA.
- This understanding may explain previously observed anomalies in DKA patient data.