Mất nước có thể gây ra một sự gia tăng ở các cấp độ trong huyết tương của chất hóa học thường bao gồm protein, canxi, amylase, lactate dehydrogenase, transaminase, và creatinin kinase. Trạng thái bệnh tiềm ẩn liên quan đến mức độ này cần phải được loại trừ | HYPEROSMOLAR HYPERGLYCEMIC STATE 639 Dehydration may cause a rise in the plasma levels of routine chemistries including calcium protein amylase lactate dehydrogenase transaminases and creatinine kinase. Underlying disease states associated with these levels need to be excluded however. Patients present with prerenal azotemia and the initial BUN to creatinine ratio may exceed 30 1. Leukocytosis is often present secondary to stress demarginalization and hemoconcentration 7 . Infection however should be ruled out as the cause of any marked elevation in white blood cell count. Hemoglobin and hematocrit concentrations may be elevated falsely because of hemoconcentration and anemia should be suspected in a patient with a normal hematocrit on examination 20 . A mild high anion gap metabolic acidosis characterized by an arterial pH above and bicarbonate level greater than 15 is common in HHS 22 33 . This acidosis can be multifactorial contributed to by dehydration renal failure starvation or mild lactic acidosis. Vomiting or the use of thiazide diuretics can cause a metabolic alkalosis that can mask the degree of acidosis 4 12 22 . If acidosis is severe lactic acidosis caused by hypovolemia and decreased perfusion underlying infection or other concurrent severe illness eg ischemic bowel should be considered 4 . Arterial blood gas measurements can help clarify what is sometimes a complicated mixed acid base picture and indicate other cardiac or pulmonary comorbidities. Although HHS is described as a nonketotic hyperosmolar state there is often some elevation of serum ketones including b-hydroxybutyrate which are related mostly to the starvation ketosis or to dehydration 2 19 . Urinalysis always is indicated and may demonstrate some degree of ketonuria also. Gross proteinuria suggests the presence of underlying renal disease. Other studies Other diagnostic studies are obtained routinely in the ED evaluation to look for precipitating or underlying illnesses. The initial .
