Among 68 type 1 diabetes patients presenting with DKA-related codes, cannabis users had significantly higher pH (7.42 vs. 7.09) and bicarbonate (19.2 vs. 9.1), suggesting a distinct hyperglycemic ketosis from CHS rather than true DKA.
Endocrinologists, emergency physicians, and diabetes care teams.
ROC AUC of 0.99 for cannabis use predicting CHS-related ketosis vs. true DKA
What the researchers found
Cannabis users had dramatically different lab profiles than non-users: pH 7.42 vs. 7.09 and bicarbonate 19.2 vs. 9.1 mmol/L (both p<0.0001). The ROC curve for cannabis predicting hyperglycemic ketosis from CHS had an area of 0.9892, indicating near-perfect discrimination.
Why it matters
Misdiagnosing CHS-related vomiting as DKA in type 1 diabetes leads to unnecessary aggressive treatment. This study provides clear lab criteria to differentiate the two conditions.
The numbers in context
Patients: 68. DKA events: 172. Cannabis users pH: 7.42 vs. 7.09 non-users. Bicarbonate: 19.2 vs. 9.1 mmol/L. ROC AUC: 0.9892. HK-CHS threshold: pH >=7.4, bicarbonate >=15.
How the study worked
Retrospective analysis of 68 adults with type 1 diabetes presenting with DKA-related ICD-10 codes (172 events). Cannabis use defined by positive urine test. Used linear mixed models and ROC analysis to distinguish hyperglycemic ketosis from CHS (pH >=7.4, bicarbonate >=15) from true DKA.
What this study cannot tell us
Small sample. Retrospective design. Cannabis use based on urine testing (indicates recent use, not necessarily current intoxication). Single-center study.
How to read the evidence
Small but well-analyzed cohort with near-perfect diagnostic discrimination.
When this study was published
Published in 2022.
The bigger picture
As cannabis use increases among young adults with type 1 diabetes, clinicians need clear diagnostic tools to distinguish CHS-related ketosis from true metabolic decompensation.
Questions still open
- How often is CHS misdiagnosed as DKA in type 1 diabetes? Could a pH threshold of 7.4 be incorporated into DKA protocols for cannabis screening?
Common questions
Can cannabis use mimic diabetic ketoacidosis?
How can doctors tell the difference?
Read the original research
Differentiating Diabetic Ketoacidosis and Hyperglycemic Ketosis Due to Cannabis Hyperemesis Syndrome in Adults With Type 1 Diabetes.
Diabetes care, 45(2), 481-483
Citation
Akturk, Halis Kaan; Snell-Bergeon, Janet; Kinney, Gregory L; Champakanath, Anagha; Monte, Andrew; Shah, Viral N. (2022). Differentiating Diabetic Ketoacidosis and Hyperglycemic Ketosis Due to Cannabis Hyperemesis Syndrome in Adults With Type 1 Diabetes.. Diabetes care, 45(2), 481-483. https://doi.org/10.2337/dc21-1730
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