Spurious Serum Creatinine Elevations in Ketoacidosis

Abstract

Diabetic ketoacidosis is usually accompanied by volume depletion and prerenal azotemia. However, the case reported here and a chart review of 10 patients with diabetic ketoacidosis showed creatinine concentration to be disporportionately elevated compared to the blood urea nitrogen level on admission, compatible with true renal insufficiency. Investigation showed most of this elevation in creatinine to be artifactual and due to interference of acetoacetate in the automated methods for measuring creatinine. A manual method that excluded noncreatinine interfering chromagens showed no interference. This manual method should be used to measure creatinine in patients admitted with ketoacidosis to exclude the possibility of coexistent renal insufficiency.