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

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posted on 2021-12-08, 16:27 authored by Halis Kaan Akturk, Janet Snell-Bergeon, Gregory L Kinney, Anagha Champakanath, Andrew Monte, Viral N. Shah

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 positive urine test for cannabis. Linear mixed models were used to define HK-CHS (pH ≥7.4 with bicarbonate ≥ 15) and sensitivity and specificity were calculated using receiver operating characteristic (ROC).


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) (p<0.0001) compared to non-users. The area under the ROC for positive cannabis urine test predicting HK-CHS was 0.9892.


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


There is no funding for this study.