Summary
A diabetic patient presented with weight loss, ketosis, and hyperventilation, thus mimicking the clinical picture of diabetic ketoacidosis. Laboratory investigations revealed alkalemia and a pattern consistent with a triple derangement of acid-base equilibrium: respiratory alkalosis, metabolic acidosis and metabolic alkalosis. High cortisol level suggested a genesis of ketosis different from diabetes mellitus. The patient died suddenly from acute gastrointestinal bleeding. Autopsy showed a carcinoma of the head of the pancreas with secondary portal hypertension and rupture of varices. Pulmonary micrometastases were demonstrated. It is suggested that stress hormones were the main cause of the ‘ketoalkalotic’ pattern observed.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Bleicher S.: Keto is not always acidosis: ‘heartburn’ can be relevant — Diabetes Outlook3, 3, 1967.
Emmett M., Narins R. G.: Clinical use of the anion gap — Medicine (Baltimore)56, 38, 1977.
Fras I., Litin E. M., Bartholomew L. G.: Mental symptoms as an aid in the early diagnosis of carcinoma of the pancreas — Gastroenterology55, 191, 1968.
Iqbal S. J., Walsh D. B.: Diabetic ketoalkalosis: a readily diagnosed non-entity? — Brit. med. J.ii, 1389, 1976.
Jiménez J. A., Damiano A., Fernàndez E., Rodríguez-Rubio F., Garrido M.: Metabolic alkalosis in diabetic ketosis — J. Amer. med. Ass.233, 1193, 1975.
Johnston D. G., Alberti K. G. M. M.: Hormonal control of ketone bodies metabolism in the normal and diabetic state — Clin. Endocrinol. Metab.11, 329, 1982.
Koett J., Howell J., Steinberg S., Wolff P.: Diabetic ketoalkalosis — Clin. Chem.25, 1329, 1979.
Lim K. C., Walsh C. H.: Diabetic ketoalkalosis: a readily misdiagnosed entity — Brit. med. J.ii, 19, 1976.
Mazzara J. T., Ayres S. M., Grace W. J.: Extreme hypocapnia in the critically ill patient — Amer. J. Med.56, 450, 1974.
Melrose E., Morgan A., Harrower A. D. B., Smith A. W. M.: Diabetic ketoalkalosis — Brit. med. J.ii, 237, 1976.
Narins R. G., Emmett M.: Simple and mixed acid-base disorders: a practical approach — Medicine (Baltimore)59, 161, 1980.
O’Reilly D. St. J., Delamere J. F.: Cause of alkalosis in ‘diabetic ketoalkalosis’ — Clin. Chem.26, 171, 1980.
Roggin G. M., Moses D., Kautcher M., Wishner W., Shuman C.: Ketosis and metabolic alkalosis in a patient with diabetes — J. Amer. med. Ass.211, 296, 1970.
Schade D. S., Eaton R. P.: Differential diagnosis and therapy of hyperketonemic state — J. Amer. med. Ass.241, 2064, 1979.
Shirley R., Martin J. V.: Diabetic ketoalkalosis — Brit. med. J.ii, 943, 1976.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Greco, A.V., Bertoli, A., Caputo, S. et al. Ketoalkalosis as a result of triple derangement of acid-base equilibrium in a diabetic patient. Acta diabet. lat 22, 71–77 (1985). https://doi.org/10.1007/BF02591095
Received:
Issue Date:
DOI: https://doi.org/10.1007/BF02591095