Ketoalkalosis: Masked Presentation of Diabetic Ketoacidosis With Literature Review

Abstract

Most dreaded complication in type 1 diabetes mellitus remains diabetic ketoacidosis (DKA): plasma blood glucose > 250 mg/dL, serum bicarbonate < 18 mEq/L, anion gap metabolic acidosis and ketosis. Insulin deficiency with high levels of glucagon and stress hormones causing ketogenesis in liver, elevated lipolysis in peripheral tissues, and increased free fatty acids contribute the formation of ketones leading to metabolic acidosis. And hence DKA is also termed as ketoacidosis. Unusually, patients with diuretic use, alkali ingestion, intractable vomiting, or hypercortisolism may present with alkalemia in DKA. Contraction (Metabolic) Alkalosis masquerades metabolic acidosis with anion gap and low to normal bicarbonate that uncovers on provision of intravenous fluids. We present a case of a 25-year-old female with DKA presenting with intractable vomiting, alkalotic pH and high anion gap.




J Endocrinol Metab. 2017;7(6):194-196
doi: https://doi.org/10.14740/jem472w