leukocyte count and glycemic emergencies

Q:  Leukocytosis is usually proportional to the degree of ketonemia in patients with hyperglycemic emergencies.

A) True

B) False

Answer: A

By default, most patients with Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS - also known as hyperosmotic hyperglycemic nonketotic state - HHNK) have some degree of leukocytosis. WBC level is usually proportional to the degree of ketonemia. This leukocytosis is due to hypercortisolemia and increased catecholamine secretion.

Clinicians should be vigilant about possible underlying infection/sepsis, which may have led to this hyperglycemic emergency, particularly if there is an associated history, out of proportion high WBC account like 25,000/microL, or if there is a significant bandemia of about 10 percent.

#endocrinology

#ID

References:

1. Nematollahi LR, Taheri E, Larijani B, et al. Catecholamine-induced leukocytosis in acute hypoglycemic stress. J Investig Med 2007; 55:S262.

2. Slovis CM, Mork VG, Slovis RJ, Bain RP. Diabetic ketoacidosis and infection: leukocyte count and differential as early predictors of serious infection. Am J Emerg Med 1987; 5:1.