Aurora, CO: Type 1 diabetes (T1D) patients presenting with diabetic ketoacidosis (DKA) have higher bicarbonate levels and pH following cannabis use versus those not using cannabis, according to recently published data. So, in the patients having DKA and higher pH, especially pH ≥7.4, cannabis use should be considered in the differential diagnosis. The study appears in the journal Diabetes Care.
T1D patients presenting with DKA symptoms may instead have ketosis due to cannabis hyperemesis syndrome, and misdiagnosis can be avoided by adopting several criteria, the researchers note.
Mostly, physicians rely on PH and bicarbonate levels for diagnosing and classifying DKA and making floor vs. ICU admission decisions. In the study, the researchers found that relying only on these parameters (pH and bicarbonate) can be misleading in cannabis users with type 1 diabetes.
The objective of the study conducted by Halis Kaan Akturk, Barbara Davis Center for Diabetes, University of Colorado, Aurora, CO, and colleagues was to differentiate diabetic ketoacidosis from hyperglycemic ketosis due to cannabis hyperemesis syndrome (HK-CHS) in adults with type 1 diabetes.
For this purpose, the researchers analyzed 68 patients with 172 DKA events out of 295 adults with type 1 diabetes who were seen with DKA-related ICD-10 codes. Cannabis use was defined as a positive urine test result for cannabis.
HK-CHS (pH ≥7.4 with bicarbonate ≥15 mmol/L [mEq/L]) was defined using linear mixed models, and sensitivity and specificity were calculated using the receiver operating characteristic (ROC) curve.
Key findings include:
Cannabis users had significantly higher pH (7.42 ± 0.01 vs. 7.09 ± 0.02) and bicarbonate (19.2 ± 0.61 vs. 9.1 ± 0.71 mmol/L) compared with nonusers.
The area under the ROC curve for a positive cannabis urine test result predicting HK-CHS was 0.9892.
To conclude, cannabis use should be considered in the differential diagnosis, in patients who present with DKA and higher pH, especially pH ≥7.4.
Reference:
Halis Kaan Akturk, Janet Snell-Bergeon, Gregory L Kinney, Anagha Champakanath, Andrew Monte, Viral N. Shah; Differentiating Diabetic Ketoacidosis and Hyperglycemic Ketosis Due to Cannabis Hyperemesis Syndrome in Adults With Type 1 Diabetes. Diabetes Care 2021; dc211730. https://doi.org/10.2337/dc21-1730