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March 17, 1975

Diabetic Ketoacidosis Appearing as Carbon Monoxide Poisoning

Author Affiliations

From the Section of Medical Chest Diseases, Department of Medicine (Dr. Hodgkin), and the Pulmonary Function Laboratory (Mr. Chan), Loma Linda University Medical Center, Loma Linda University, School of Medicine, Loma Linda, Calif.

JAMA. 1975;231(11):1164-1165. doi:10.1001/jama.1975.03240230038018

THE VALUE of the differential spectrophotometer in determining hemoglobin values and saturations of carboxyhemoglobin (COHb) and oxyhemoglobin (O2Hb) has been demonstrated.1 The differential spectrophotometer (IL 182 CO-Oximeter) is used in our pulmonary function laboratory for routine blood-gas analysis.

Recently, a comatose patient was first seen in the emergency room with metabolic acidosis. Carbon monoxide poisoning was suspected on the basis of initial arterial blood-gas testing, which showed a markedly increased level of COHb. However, it was subsequently determined that the patient had very high levels of serum lipids resulting in interference with the analyzer's spectrophotometric method for measuring hemoglobin, COHb, and O2Hb.

Since this problem with the differential spectrophotometer we use has not previously been described, we decided to collect some quantitative data on the effect of serum lipids on the performance of this machine.

Report of a Case  The patient was a 27-year-old woman