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Ketoalkalosis in Diabetics: A Diabetic Ketoacidosis Alkalemic Variant Commonly Overlooked in Relation to Mixed Acid-Base Disorders

Joel Goldman

It is discussed a case of diabetic ketoacidosis that presented with alkalemia (pH 7.61) rather than acidemia (pH 7.35). Even though ketosis is present, severe vomiting causes electrolyte depletion and hypovolemia, which in turn causes bicarbonate reabsorption and an alkaline state. Alkalemia can also arise from severe respiratory alkalosis. The implementation of the appropriate treatment will result from the identification of alkalemia and its cause.

Alkalaemia and diabetic ketoacidosis in two type 1 diabetic patients are described by us. Twenty-three cases have been reported, and vomiting, taking alkali, and taking diuretics were the main causes of alkalaemia. Patients with poorly controlled diabetes who already had autonomic neuropathy, according to our report, are at risk.