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Spurious Serum Creatinine Elevations in Ketoacidosis

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Dr. Molitch is a Clinical Associate of the General Clinical Research Centers program, U.S. Public Health Service (grant RR0054-7).

Tufts University School of Medicine, New England Medical Center; Boston, Massachusetts

Ann Intern Med. 1980;93(2):280-281. doi:10.7326/0003-4819-93-2-280
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Diabetic ketoacidosis is usually accompanied by dehydration resulting in prerenal azotemia, in which the levels of blood urea nitrogen are elevated out of proportion to those of the serum creatinine (1).

In contrast, one patient who had been admitted to our hospital in diabetic ketoacidosis a number of times consistently displayed serum creatinine levels repeatedly elevated out of proportion to her blood urea nitrogen levels but had normal renal function between episodes of ketoacidosis. Investigation showed the elevated creatinine levels to be due to the artifactual interference of acetoacetate in the automated measurement of serum creatinine, a fact not widely


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