Please provide the following to the laboratory to aid in patient evaluation. 
This form is in the ER, and in the Laboratory Text Index.

Patient Name: _______________________________________________   Age: ______________  Sex: ________

Referring Physician Name: _________________________________________________

Phone Number to reach physician: __________________________________________

Chief Complaint: __________________________________________________________________________________

History of patient illness:____________________________________________________________________________

Past medical history:_______________________________________________________________________________

Physical Exam:____________________________________________________________________________________

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* NL = normal

1. Only one point of time in the normal disposition of each of these ingredients is represented by these results.

2. A trace of ketones may be observed in individuals who have not eaten for many hours, but ketones are nearly always 

    negative on dilutions of the serum.                                                  

3. Acetest is specific for the detection of acetoacetic acid and acetone.  It is about 10 more times sensitive to acetoacetic

    acid than acetone and will not react with betahydroxybutyric acid.                                                                

4. Ethylene glycol is metabolized to oxalate; oxalate crystals may be found in the urine.

5. Clinical history, ketones positive on diluted serum, and elevated glucose will identify this group.

6. Alcoholic ketoacidosis usually occurs 1-2 days after binge drinking.  Ethanol has disappeared from the blood. The ketone

    test is weak because B-hydroxybutyrate is the most abundant ketone in this setting.