The patient was a teenage African American female with a 2-week history of polyuria and polydipsia. There was no weight loss or nausea. She also presented with bilateral pain in her lower extremities and chest pain. During transit by EMS, her capillary glucose measured with a point-of-care device was 368 mg/dL.
These were her labs on admission:
Patient
Result
Reference Interval
Venous pH
7.26
7.3-7.4
Venous pCO2
23 mm Hg
42-53
Venous pO2
73 mm Hg
35-45
Venous HCO3-
10 meq/L
21-27
Venous base deficit
16 meq/L
0-3
Sodium
134 mmol/L
136-145
Potassium
4.1 mmol/L
3.3-5.1
Chloride
111 mmol/L
98-107
Carbon dioxide
8 mmol/L
22-30
Creatinine
0.62 mg/dL
0.40-1.10
BUN
6 mg/dL
6-20
Glucose
181 mg/dL
65-99
Urine glucose
>1000 mg/dL
Negative
Urine ketones
>150 mg/dL
More admission data:
WBC
20.50 K/uL
4.5-13.5K
Hemoglobin
9.9 g/dL
11.5-15.5
Hematocrit
28%
RBC count
3.16 million
4.0-5.2
MCV
87 fL
77-95
Red cell distribution width
16%
11-14
Corrected reticulocyte count
7.4%
0.5-1.8
Neutrophils
70%
40-80
Lymphocytes
18%
20-45
Monocytes
7%
2-10
Eosinophils
2%
0-8
Basophils
1%
0-2
Large unstained cells
3%
0-4
Platelet count
183 K/uL
150-450K
Hemoglobin A1c was requested and was measured at zero (0) percent. Below is the HPLC tracing. Why wasn’t any A1c measured?
ADA Endorses HbA1c for Diabetes Diagnosis. CLN February 2010
Expert Committee Endorses HbA1c Test for Diagnosing Diabetes. CLN August 2009