Diabetic ketoacidosis masked by both Euglycemia and a primary metabolic alkalosis.

IF 0.5 Q3 MEDICINE, GENERAL & INTERNAL
Oxford Medical Case Reports Pub Date : 2024-07-13 eCollection Date: 2024-07-01 DOI:10.1093/omcr/omae071
Matthew F Hillock, Cierra Jarmon, Anastasia E Metropulos, Rachael King, Stefan Tchernodrinski, Daniel R Principe
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引用次数: 0

Abstract

Diabetic ketoacidosis (DKA) is an acute, life-threatening metabolic complication of diabetes classically associated with hyperglycemia, metabolic acidosis, and ketosis. Though relatively uncommon, patients can also develop DKA with relative euglycemia, further complicating diagnosis. Here, we describe the case of a patient who presented with intractable vomiting secondary to diabetic gastroparesis. He was euglycemic, non-acidemic, and serum bicarbonate was within normal limits. However, labs were significant for ketonuria, an elevated anion gap, and an elevated beta-hydroxybutyrate. Given the high concern for euglycemic DKA in the setting of a competing primary metabolic alkalosis, he was transferred to the intensive care unit for intravenous insulin infusion and fluid resuscitation with significant clinical improvement and normalization of laboratory results. This serves as an important reminder that DKA can be masked by euglycemia as well as additional metabolic derangements, and should be suspected in any diabetic patient with an anion gap and/or ketosis.

由优格血症和原发性代谢性碱中毒掩盖的糖尿病酮症酸中毒。
糖尿病酮症酸中毒(DKA)是一种危及生命的急性糖尿病代谢并发症,通常与高血糖、代谢性酸中毒和酮症酸中毒有关。尽管相对少见,但患者也可能在相对优血糖的情况下发生 DKA,从而使诊断更加复杂。在这里,我们描述了一例继发于糖尿病性胃瘫的顽固性呕吐患者。患者血糖正常,无高血糖,血清碳酸氢盐在正常范围内。然而,化验结果却显示酮尿、阴离子间隙升高和β-羟丁酸升高。考虑到在出现原发性代谢性碱中毒的情况下极易发生优生酮症酸中毒,他被转入重症监护室进行胰岛素静脉注射和液体复苏,临床症状明显改善,实验室结果也趋于正常。这一病例提醒我们,DKA 可被优生血糖和其他代谢紊乱所掩盖,任何出现阴离子间隙和/或酮症酸中毒的糖尿病患者都应怀疑 DKA。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Oxford Medical Case Reports
Oxford Medical Case Reports MEDICINE, GENERAL & INTERNAL-
CiteScore
0.90
自引率
0.00%
发文量
125
审稿时长
19 weeks
期刊介绍: Oxford Medical Case Reports (OMCR) is an open access, peer-reviewed online journal publishing original and educationally valuable case reports that expand the field of medicine. The journal covers all medical specialities including cardiology, rheumatology, nephrology, oncology, neurology, and reproduction, comprising a comprehensive resource for physicians in all fields and at all stages of training. Oxford Medical Case Reports deposits all articles in PubMed Central (PMC). Physicians and researchers can find your work through PubMed , helping you reach the widest possible audience. The journal is also indexed in the Web of Science Core Collection . Oxford Medical Case Reports publishes case reports under the following categories: Allergy Audiovestibular medicine Cardiology and cardiovascular systems Critical care medicine Dermatology Emergency medicine Endocrinology and metabolism Gastroenterology and hepatology Geriatrics and gerontology Haematology Immunology Infectious diseases and tropical medicine Medical disorders in pregnancy Medical ophthalmology Nephrology Neurology Oncology Paediatrics Pain Palliative medicine Pharmacology and pharmacy Psychiatry Radiology, nuclear medicine, and medical imaging Respiratory disorders Rheumatology Sexual and reproductive health Sports Medicine Substance abuse.
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