WBC in DKA

Q: Leukocytosis in Diabetic ketoacidosis (DKA) is proportional to the degree of ketonemia.

A) True

B) False

Answer: A (True)

DKA is classically a triad of

• hyperglycemia
• anion gap metabolic acidosis
• ketonemia

Normoglycemic DKA may also occur.

Although leukocytosis is not a very commonly seen marker in DKA, it is usually proportional to the degree of ketonemia. Leukocytosis occurs due to hypercortisolemia and increased catecholamine secretion, which correlates with ketonemia.

Said that many times, infection may precipitate DKA, and in such cases, a white blood cell count over 25,000/microL or more than 10 percent bands should increase the suspicion of underlying sepsis.

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References:

1. Stentz FB, Umpierrez GE, Cuervo R, Kitabchi AE. Proinflammatory cytokines, markers of cardiovascular risks, oxidative stress, and lipid peroxidation in patients with hyperglycemic crises. Diabetes 2004; 53:2079.

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

3. 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.