Diabetic ketoalkalosis: a readily misdiagnosed entity.

Diabetic ketoalkalosis: a readily misdiagnosed entity An essential part of the treatment of diabetic ketoacidosis. is the replacement of fluid and electrolytes. Though routine use of alkali is questionable, it is often used in the early stages of treatment. We describe two patients diagnosed as having diabetic ketoacidosis who were later found to have a metabolic alkalosis. The use of alkali replacement in these patients would have been inappropriate and potentially hazardous. Case reports Case 1-A 24-year-old woman who had been treated with insulin for 11 years was admitted to hospital in December 1974 with a history of nausea for three weeks, severe vomiting for 24 hours, and diarrhoea for four hours. on her breath. Urine analysis showed 2 00 glucose and 3 + ketones. Diabetic ketoacidosis was diagnosed, and after standard investigations had been ordered she was given a normal saline infusion, potassium chloride supplements , and hourly intramuscular insulin. Subsequently the results of the initial investigations showed a metabolic alkalosis (see table). Within six hours all biochemical values were normal. The vomiting ceased within 48 hours, and a barium-meal examination at this stage showed nothing abnormal. Studies of autonomic nerve function showed only marginal abnormalities. During the next six months she was admitted twice in unequivocal diabetic ketoacidosis. In December 1975 she was admitted with a history and clinical features identical with those of December 1974.