What are the implications of hyperglycemia, hypocalcemia, and otherwise normal lab results?

From the Guidelines

The patient's elevated glucose level of 216 mg/dL is the primary concern and requires immediate follow-up testing, such as HbA1c, to determine if this is a persistent issue requiring treatment, as indicated by the American Diabetes Association guidelines 1. The laboratory results show mostly normal values with a few notable exceptions. The glucose level is significantly elevated, indicating hyperglycemia which may suggest diabetes or impaired glucose tolerance. The calcium level is slightly low at 8.7 mg/dL, representing mild hypocalcemia. All other values, including electrolytes (sodium, potassium, chloride, CO2), kidney function tests (BUN, creatinine, eGFR), liver function tests (SGOT, SGPT, alkaline phosphatase, bilirubin), and protein levels (total protein, albumin, globulin) are within normal limits. Some key points to consider in the management of this patient's condition include:

• The diagnosis of diabetes can be made based on a HbA1c level of 6.5% or higher, a fasting plasma glucose level of 126 mg/dL or higher, or a 2-hour plasma glucose level of 200 mg/dL or higher during an oral glucose tolerance test, as outlined in the guidelines for laboratory analysis in the diagnosis and management of diabetes mellitus 1.
• The patient's elevated glucose level requires prompt attention to prevent potential complications, such as microvascular and macrovascular disease, as discussed in the position statement of the American Diabetes Association and the American College of Cardiology Foundation 1.
• The mild hypocalcemia may need further evaluation, especially if the patient has symptoms like muscle cramps or tingling.
• The anion gap is at the lower limit of normal at 10 mmol/L, which is not concerning. Overall, the primary concern from these results is the elevated blood glucose, which should be addressed through appropriate medical follow-up, including further testing and potential treatment to achieve a target HbA1c level of less than 7%, as recommended by the American Diabetes Association 1.

From the Research

Laboratory Results

• Sodium level: 137 mEq/L (within normal range of 136-145 mEq/L)
• Potassium level: 4.6 mEq/L (within normal range of 3.5-5.1 mEq/L)
• Chloride level: 107 mEq/L (within normal range of 98-107 mEq/L)
• CO2 level: 25 mEq/L (within normal range of 23-31 mEq/L)
• Glucose level: 216 mg/dL (high, above normal range of 60-99 mg/dL)
• Blood urea nitrogen (BUN) level: 11 mg/dL (within normal range of 8-21 mg/dL)
• Creatinine level: 1.0 mg/dL (within normal range of 0.7-1.3 mg/dL)
• BUN/creat ratio: 11.0
• eGFR: 82 mL/min/1.73m2 (above 59 mL/min/1.73m2)
• Calcium level: 8.7 mg/dL (low, below normal range of 9.0-10.2 mg/dL)
• Total protein level: 6.6 g/dL (within normal range of 5.8-7.8 g/dL)
• Albumin level: 3.8 g/dL (within normal range of 3.4-4.8 g/dL)
• Globulin level: 2.8 g/dL (within normal range of 1.7-3.6 g/dL)
• A/G ratio: 1.4 (above 1.1)
• SGOT level: 20 IU/L (within normal range of 10-40 IU/L)
• SGPT/ALT level: 23 IU/L (within normal range of 10-35 IU/L)
• Alkaline phosphatase level: 93 IU/L (within normal range of 56-119 IU/L)
• Bilirubin total level: 0.6 mg/dL (within normal range of 0.3-1.2 mg/dL)
• Anion gap: 10 mmol/L (within normal range of 10.0-20.0 mmol/L)

Glucose Level

• The glucose level is high at 216 mg/dL, which is above the normal range of 60-99 mg/dL
• According to 2, inpatient hyperglycemia is common and is associated with an increased risk of hospital complications, higher healthcare resource utilization, and higher in-hospital mortality rates
• 3 states that continued elevation of blood glucose levels can contribute to progressive micro- and macrovascular complications, leading to renal, nerve, and ocular damage
• 4 suggests that patients with elevated glycated hemoglobin A1c seem to better tolerate hyperglycemia and large glucose fluctuations during critical illness

Diagnosis of Diabetes

• 5 recommends that the diagnosis of diabetes be made if hemoglobin A1c (HbA1c) level is greater than or equal to 6.5% and confirmed with a repeat HbA1c test
• 6 compares the current diagnostic criterion of HbA1c with fasting and 2-hour plasma glucose concentration, and finds that HbA1c ≥ 6.5% detects less than 50% of diabetic patients defined by fasting plasma glucose and less than 30% of diabetic patients defined by 2-hour plasma glucose