does DKA or HHNKS always accompany high blood sugar

classicdame, MSN, EdD · Dec 16, 2010

there is some compensation that the body undergoes to prevent ketosis, and this will vary widely among patients. However, >700 surely seems high enough to show acetone. The cardiac "flare" may really have been part of her de-compensation.

afteralltheseyears · Dec 17, 2010

If ketones are being spilled in the urine and the serum ketones are elevated will the patient always be acidotic or might there be a certain amount of buffering the body can to do prevent acidosis? The patient did not have kussmaul respirations or fruity breath so I wonder if that means the patient was not in DKA? thanks for sharing your knowledge.

classicdame, MSN, EdD · Dec 21, 2010

Kussmaul breathing is a late sign. If the acetone ratio is high, the patient is acidotic, regardless of other symptoms. Yes, the kidneys do buffer but eventually they reach their limit too.

The first time I had my glucose tested it was 520. I had been working 12 hour shifts, at night, and my biggest complaint was blurry vision. But my A1C was >12, so I must have had high glucose for some time. I learned then the difference between signs and symptoms. Lab results were signs of diabetes. My symptoms were too vague for a diagnosis.

Myxel67 · Mar 18, 2011

BG values associated with HHS range from 600 to 2000 mg/dl. So pt with BG in 700's might not yet have the level of dehydration associated with HHS. Most pt's I have seen with HHS have had BG values from around 900 to 1300 or 1400. DKA occurs at much lower BG levels, but is dependent on how much insulin is present. A type 1 diabetic who had not had any insulin for 2 or 3 days might develop DKA with a relatively low BG (250 - 400, for example). Check pH from ABG's and anion gap from chemistry. A nondiabetic may have urine ketones (but no acetone in blood) because of lack of carbohydrate intake. It is also possible for a type 2 diabetic to have a moderate level of acetone in the blood, but not be acidotic. An ER doc diagnosed me with DKA a couple of years ago. I told her it was unlikely and that the blood acetone was probably because I had not eaten in 5 days (severe influenza), ABG showed pH slightly elevated (7.48 - 7.52 which was probably result of breathing difficulty and hyperventilation r/t pneumonia and anxiety (not Kussmaul respirations.) Anion gap was WNL. BG was 245--high for me, but not likely to produce DKA in a person with type 2 DM. She called an endo to see me anyway. He came in to tell me that I did not have DKA, which was no surprise to me...