From the Guidelines
The patient's glucose level is slightly elevated at 101 mg/dL, which is above the normal range of 70-99 mg/dL, and according to the standards of medical care in diabetes-2018, a blood glucose level ≥140 mg/dL is considered hyperglycemia, but levels between 100-139 mg/dL may also require attention 1. The lab results show a few abnormalities that should be addressed.
- The anion gap is low at 5 (normal range 6-18)
- Glucose is slightly elevated at 101 mg/dL (normal range 70-99)
- The BUN/creatinine ratio is high at 24.2 (normal range 12.0-20.0)
- Total bilirubin is low at 0.2 mg/dL (normal range 0.3-1.2) The slightly elevated glucose suggests possible pre-diabetes, and monitoring of blood sugar levels is recommended, as hyperglycemia in hospitalized patients is defined as blood glucose levels ≥140 mg/dL, but attention should also be given to levels between 100-139 mg/dL 1. The high BUN/creatinine ratio could indicate dehydration or increased protein catabolism, and improved hydration is recommended. The low anion gap is uncommon and might be due to laboratory error, hypoalbuminemia (though albumin is normal here), or the presence of unmeasured cations. The low total bilirubin is generally not clinically significant. Overall, these results suggest the need for improved hydration and follow-up glucose testing.
- A repeat metabolic panel in 3-6 months would be reasonable to monitor these values,
- Along with lifestyle modifications including increased water intake and dietary changes to manage blood glucose. If glucose remains elevated, further evaluation for diabetes may be warranted, as an admission A1C value ≥6.5% suggests that diabetes preceded hospitalization 1.
From the Research
Laboratory Results
The patient's laboratory results show the following:
- Sodium level: 136 mmol/L, within the normal range of 136-145 mmol/L
- Potassium level: 4.4 mmol/L, within the normal range of 3.6-5.1 mmol/L
- Chloride level: 104 mmol/L, within the normal range of 98-107 mmol/L
- CO2 level: 27 mmol/L, within the normal range of 22-32 mmol/L
- Anion Gap: 5, within the normal range of 6-18, but reported as low
- Glucose level: 101 mg/dL, slightly above the normal range of 70-99 mg/dL, reported as high
- BUN level: 15 mg/dL, within the normal range of 8-20 mg/dL
- Creatinine level: 0.62 mg/dL, within the normal range of 0.60-1.30 mg/dL
- eGFR: 129 mL/min/1.73m2, above the normal threshold of 60 mL/min/1.73m2
- BUN/Creatinine Ratio: 24.2, above the normal range of 12.0-20.0, reported as high
Relevant Studies
Studies have shown that monitoring blood glucose levels is crucial in managing diabetes and preventing complications 2, 3, 4. However, the patient's glucose level is only slightly elevated, and there is no indication of diabetes diagnosis. The patient's kidney function appears to be normal, with a normal eGFR and creatinine level. However, the BUN/Creatinine Ratio is high, which may indicate dehydration or other conditions 5, 6.
Additional Tests
Urinalysis may be useful in further evaluating the patient's condition, particularly in assessing kidney function and detecting potential biomarkers for diabetes or other conditions 5, 6.