ABDOMINAL PAIN AND HEMATOLOGICAL CHANGES IN URGENT AND EMERGENCY CARE: CLINICAL AND LABORATORY ASPECTS IN THE DIFFERENTIAL DIAGNOSIS BETWEEN ACUTE APPENDICITIS AND DIABETIC KETOACIDOSIS

Abstract

Objective: To analyze the clinical, hematological, and biochemical criteria that support the differential diagnosis between acute appendicitis and diabetic ketoacidosis (DKA) in emergency units. Methodology: Integrative literature review conducted in PubMed, SciELO, LILACS, and Scopus databases, covering the period from 2020 to 2026. The final sample consisted of 50 references, including WSES, ADA, and SBD guidelines. Results: Pain in acute appendicitis is migratory and associated with signs of peritoneal irritation (70% of cases), whereas in DKA it is diffuse and correlates with severe acidosis (bicarbonate < 15 mEq/L). Both conditions present leukocytosis; however, in DKA, it is transient and results from acute stress, while in appendicitis, neutrophilia is persistent and accompanied by high CRP. Metabolic stabilization with insulin and hydration resolves DKA "acute pseudo-abdomen" within 12 hours; persistent pain after this period indicates surgical pathology. Diagnostic delay in diabetic patients increases the risk of appendiceal perforation to 35%. Conclusion: Secure differential diagnosis requires the interpretation of classical semiology in light of the acid-base balance (anion gap and pH). Internal environment stabilization must precede surgical intervention to avoid cardiovascular collapse, ensuring care based on diagnostic precision and the reduction of negative laparotomies.