What would acidosis and ketosis on a Mosaic Oats test indicate?

From the Guidelines

Acidosis and ketosis on a Mosaic Oats test indicate a potentially life-threatening condition called diabetic ketoacidosis (DKA), requiring immediate medical attention. This finding suggests uncontrolled diabetes or severe starvation, characterized by an abnormally high level of acidity in the blood and the presence of ketone bodies. According to the most recent guidelines 1, the management goals include restoration of circulatory volume and tissue perfusion, resolution of hyperglycemia, and correction of electrolyte imbalance and acidosis.

Key Considerations

• Treatment typically involves insulin administration, intravenous fluids, and electrolyte replacement, with a focus on addressing the underlying cause of the metabolic derangement.
• The use of bicarbonate in patients with DKA is generally not recommended, as it has been shown to make no difference in the resolution of acidosis or time to discharge 1.
• Blood glucose, electrolytes, and pH should be monitored frequently to guide treatment and prevent serious complications.

Treatment Approach

• Insulin administration should be initiated with an IV bolus of regular insulin at 0.1 units/kg, followed by continuous infusion, as recommended by recent guidelines 1.
• Intravenous fluids, such as normal saline, should be administered at a rate of 15-20 mL/kg/hr initially, with adjustments made based on the patient's response.
• Electrolyte replacement, particularly potassium, is crucial to prevent complications and support the patient's recovery.

Monitoring and Adjustment

• Frequent monitoring of blood glucose, electrolytes, and pH is essential to guide treatment and prevent serious complications.
• The underlying cause of the metabolic derangement must be identified and addressed, which could include adjusting diabetes medication, treating infection, or addressing other triggers.
• Successful transition from intravenous to subcutaneous insulin requires administration of basal insulin 2–4 h before the intravenous insulin is stopped to prevent recurrence of ketoacidosis and rebound hyperglycemia 1.

From the Research

Acidosis and Ketosis on Mosaic Oats Test

• Acidosis and ketosis on a mosaic oats test may indicate a metabolic state characterized by elevated levels of ketones in the blood, often associated with diabetic ketoacidosis (DKA) 2.
• DKA is a life-threatening complication of type 1 and type 2 diabetes, resulting from an absolute or relative insulin deficiency 2.
• The presence of acidosis and ketosis may suggest a severe metabolic disruption, potentially leading to lethal complications if left untreated 3.

Diagnostic Criteria

• Traditionally, DKA has been diagnosed by the triad of hyperglycemia, metabolic acidosis, and elevated serum or urine ketones 2.
• However, recent guidelines have de-emphasized hyperglycemia due to the increasing incidence of euglycemic DKA 2.
• Electrolytes, phosphate, blood urea nitrogen, creatinine, urinalysis, complete blood cell count with differential, A1C, and electrocardiography should be evaluated to identify causes and complications of DKA 2.

Treatment and Management

• Treatment involves fluid and electrolyte replacement, insulin, treatment of precipitating causes, and close monitoring to adjust therapy and identify complications 2.
• The use of sodium bicarbonate in DKA treatment is controversial, with some studies suggesting potential adverse effects and lack of significant benefits 4, 3, 5, 6.
• Bicarbonate administration may even worsen ketosis and increase the risk of cerebral edema in children 5, 6.