From the Guidelines
Anemia in diabetic ketoacidosis (DKA) is typically pseudoanemia rather than true anemia, and no specific treatment is needed for this apparent anemia as it will correct itself once the patient is properly hydrated and the DKA is resolved. During DKA, patients experience significant fluid shifts and volume depletion, leading to hemoconcentration initially [ 1 ]. As fluid resuscitation occurs during treatment, there is hemodilution which can appear as anemia on laboratory tests. This is not a true decrease in red blood cell mass but rather a dilutional effect.
Key Considerations
- The underlying pathophysiology involves the osmotic diuresis from hyperglycemia causing severe dehydration, followed by rapid rehydration during treatment [ 1 ].
- DKA can cause falsely elevated hemoglobin A1c readings due to the formation of carbamylated hemoglobin, which should be considered when interpreting glycemic control in these patients.
- Clinicians should focus on treating the underlying DKA with insulin therapy and fluid resuscitation rather than specifically addressing the apparent anemia [ 1 ].
Management Approach
- Treatment of the underlying DKA with insulin therapy and fluid resuscitation is the primary approach, and the apparent anemia will typically resolve once the patient is properly hydrated and the DKA is resolved [ 1 ].
- If hemoglobin levels remain significantly low (typically below 7 g/dL) after adequate fluid resuscitation and DKA resolution, further investigation for true anemia should be pursued.
- The use of bicarbonate in patients with DKA has been shown to make no difference in the resolution of acidosis or time to discharge, and its use is generally not recommended [ 1 ].
From the Research
Anemia in Diabetic Ketoacidosis (DKA)
- Anemia is a common finding in people with diabetes and chronic kidney disease, and it is associated with adverse outcomes, including increased risk of all-cause and cardiovascular mortality 2.
- The relationship between anemia and DKA is not directly addressed in the provided studies, but anemia is known to be a complication of diabetes, which is a primary cause of DKA.
- Iron deficiency anemia (IDA) has been shown to contribute to the development of type II diabetes mellitus (T2DM) and can exacerbate insulin resistance (IR) in women with T2DM 3.
- Treatment of IDA with ferrous sulfate tablets has been shown to significantly reduce blood glucose (BG) and IR levels in women with T2DM 3.
- The management of DKA typically involves hospitalization for aggressive intravenous fluids, insulin therapy, electrolyte replacement, and identification and treatment of the underlying precipitating event, but anemia is not specifically addressed as a component of DKA management 4, 5, 6.