Differentiating Diabetic Ketoacidosis and Hyperglycemic Ketosis Due to Cannabis Hyperemesis Syndrome in Adults With Type 1 Diabetes

Akturk, Halis Kaan
Snell-Bergeon, Janet
Kinney, Gregory L.
Champakanath, Anagha
Monte, Andrew
Shah, Viral N.

¹Barbara Davis Center for Diabetes, University of Colorado, Aurora, CO
²Department of Epidemiology, University of Colorado, Aurora, CO
³Department of Emergency Medicine, University of Colorado, Aurora, CO

Corresponding author: Halis Kaan Akturk, [email protected]

Received August 17, 2021

Accepted November 18, 2021

Diabetes Care 45(2):p 481-483, February 2022. | DOI: 10.2337/dc21-1730

OBJECTIVE

To differentiate diabetic ketoacidosis (DKA) from hyperglycemic ketosis due to cannabis hyperemesis syndrome (HK-CHS) in adults with type 1 diabetes.

RESEARCH DESIGN AND METHODS

Of 295 adults with type 1 diabetes who were seen with DKA-related ICD-10 codes, 68 patients with 172 DKA events meeting the inclusion criteria were analyzed. Cannabis use was defined as a positive urine test result for cannabis. Linear mixed models were used to define HK-CHS (pH ≥7.4 with bicarbonate ≥15 mmol/L [mEq/L]), and sensitivity and specificity were calculated using the receiver operating characteristic (ROC) curve.

RESULTS

Cannabis users had significantly higher pH (7.42 ± 0.01 vs. 7.09 ± 0.02) and bicarbonate (19.2 ± 0.61 vs. 9.1 ± 0.71 mmol/L) (P < 0.0001) compared with nonusers. The area under the ROC curve for a positive cannabis urine test result predicting HK-CHS was 0.9892.

CONCLUSIONS

In patients who present with DKA and higher pH, especially pH ≥7.4, cannabis use should be considered in the differential diagnosis.