Abstract
A previously healthy boy was admitted with fever, tachycardia, dyspnea, and was vomiting. A blood test showed a severe metabolic acidosis with pH 7.08 and an anion gap of 36 mmol/L. His urine had an odor of acetone. The serum glucose was 5.6 mmol/L, and no glucosuria was found. Diabetic ketoacidosis could therefore be eliminated. Lactate level was normal. Tests for the most common metabolic diseases were negative. Because of herpes stomatitis, the boy had lost appetite and only been drinking Diet Coke and water the last days. Diet Coke or Coca-Cola Light is sweetened with a blend containing cyclamates, aspartame, and acesulfame potassium, all free of calories. The etiology of the metabolic acidosis appeared to be a catabolic situation exaggerated by fasting with no intake of calories. The elevated anion gap was due to a severe starvation ketoacidosis, mimicking a diabetic ketoacidosis. Pediatricians should recommend carbohydrate/calorie-containing fluids for rehydration of children with acute fever, diarrhea, or illness.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Eichler A, Förster H, Heller K, Behne M (1999) Ketoacidosis in a 14 month old child caused by fasting. Anaesthesist 48(11):813–816
Laffel L (1999) Ketone bodies: a review of physiology, pathophysiology and application of monitoring to diabetes. Diabetes Metab Res Rev 15(6):412–426
Lewis P (1991) Starvation ketosis after rehydration with diet soda. Pediatrics 88(4):806–807
Saudubray JM (2012) Clinical approach to inborn errors of metabolism in paediatrics. In: Saudubray JM, Van den Berghe G, Walter JH (eds) Inborn metabolic diseases: diagnosis and treatment, 5th edn. Berlin, Springer-Verlag, Heidelbergm, pp 3–54
Simon E, Flaschker N, Schadewaldt P, Langenbeck U, Wendel U (2006) Variant maple syrup urine disease (MSUD)—the entire spectrum. J Inherit Metab Dis 9(6):716–724
Starko KM, Ray CG, Dominiquez LB, Stromberg WL, Woodall DF (1980) Reye’s syndrome and salicylate use. Pediatrics 66(6):859–864
Steffen LM, Nettleton JA (2006) Carbohydrates: how low can you go? Lancet 367(9514):18–24
Toth HL, Greenbaum LA (2003) Severe acidosis caused by starvation and stress. Am J Kidney Dis 42(5):E16–E19
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Dahl, G.T., Woldseth, B. & Lindemann, R. Metabolic acidosis mimicking diabetic ketoacidosis after use of calorie-free mineral water. Eur J Pediatr 171, 1405–1407 (2012). https://doi.org/10.1007/s00431-012-1723-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00431-012-1723-7