Abstract
Background
Both RTA and T1DM have been associated with autoimmunity but they have been reported together rarely.
Case description
A 23-year-old female presented with DKA persisted to have acidosis after normalization of sugars. She was diagnosed with concurrent RTA on urine analysis without any underlying cause. The simultaneous occurrence of these two conditions is challenging because of the need for bicarbonate therapy in RTA; and its relative contraindication in DKA. Management of hypokalemia also becomes challenging in this condition.
Conclusion
Both RTA and DKA have a similar clinical presentation and, therefore, require a higher degree of clinical suspicion, especially in cases of non-resolving acidosis.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Fritsch M, Rosenbauer J, Schober E, Neu A, Placzek K, Holl R. Predictors of diabetic ketoacidosis in children and adolescents with type 1. Experience from a large multicenter database. Pediatr Diabetes. 2011;12:307–12.
Hess B. Acid–base metabolism: implications for kidney stones formation. Urol Res. 2006;34(2):134–8.
Dymot JA, McKay GA. Type 1 (distal) renal tubular acidosis in a patient with type 1 diabetes mellitus--not all cases of metabolic acidosis in type 1 diabetes mellitus are due to diabetic ketoacidosis. Diabet Med. 2008;25:114–5.
Raddatz V, Alvo M, Durruty P, Orellana L, Garcia de los Rios M. Decompensated diabetes mellitus and hyperchloremic metabolic acidosis: a case with both pathologies. Rev Med Chil. 1998;126:1224–8.
Garg M, Kant R. Type 1diabetes Mellitus presenting as distal renal tubular acidosis (RTA type 1). J Diab Endo Assoc Nepal. 2019;3(2):49–52.
Abdul-Rasoul M, AlTerkait A, Merza J. Persistent acidosis at presentation in a patient with type 1 diabetes: concomitant diagnosis of type 1 distal renal tubular acidosis. J Diabetes Mellitus. 2012;2:258–60.
Chua H, Schneider A, Belloma R. Bicarbonate in diabetic ketoacidosis—a systemic review. Ann Intensive Care. 2011;1:23–35. https://doi.org/10.1186/2110-5820-1-23.
Rosenbloom A. The management of diabetic ketoacidosis in children. Diabetes Ther. 2010;2010:103–20.
Hekkala A, Reunanen A, Koski M, Knipp M, Veijola R. Age-related differences in the frequency of ketoacidosis at diagnosis of type 1 diabetes in children and adolescents. Diabetes Care. 2010;33:1500–2. https://doi.org/10.2337/dc09-2344.
Soriano JR. Renal tubular acidosis: the clinical entity. JASN. 2002;13(8):2160–70.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
This article does not contain any studies with animals performed by any of the authors.
Informed consent
Informed consent was obtained from the patient for publication of the case report.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Agarwal, K., Thakur, D. & Gupta, A. Concomitant diabetic ketocacidosis and renal tubular acidosis in a type 1 diabetes mellitus patient. Int J Diabetes Dev Ctries 41, 172–174 (2021). https://doi.org/10.1007/s13410-020-00856-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13410-020-00856-x