Accuracy of Diagnosing Diabetic Ketoacidosis (DKA), Hyperosmolar Hyperglycemic State (HHS), and DKA-HHS: The Significance for Cardiac Function

Abstract

BackgroundDiabetic Ketoacidosis (DKA) and Hyperosmolar Hyperglycemic State (HHS) are severe complications of diabetes. DKA is characterized by high blood glucose, low blood bicarbonate, and high BOHB, while HHS is associated with high serum osmolality. DKA-HHS is a combination of both, which can lead to a higher mortality rate due to acidosis, electrolyte imbalances, and suboptimal IVF replacement causing cardiac injury. This study aims to determine the accuracy of the initial ED diagnosis of DKA and identify patients with HHS or DKA-HHS among those initially diagnosed with DKA. MethodsIn this retrospective, single-site study, 20 adult patients who were consecutively admitted in January 2023 with a diagnosis of DKA were re-evaluated using BMP, serum osmolality, and BOHB to determine their actual diagnosis. The diagnostic error rate was calculated, and chi-square analysis was used to compare categorical variables. ResultsUpon re-evaluation of laboratory values, 15 patients (75%) were confirmed to have DKA, 4 patients (20%) had HHS, and 1 patient (5%) had DKA-HHS. The diagnostic error rate was 25% (p<0.05), with 5 of the 20 patients misdiagnosed with DKA. ConclusionThis retrospective, single-site study suggests that the ED admitting diagnosis of DKA was incorrect in 25% of 20 subjects. This finding supports the hypothesis that the ED may fail to properly diagnose HHS or DKA-HHS. Therefore, further research is necessary to evaluate the efficacy of educating diabetic patients and ED staff on DKA, HHS, and DKA-HHS diagnostic criteria in preventing misdiagnosis and cardiac injury with the ultimate goal of improving diabetic patient care.