Lessons from practice

The hallmark of diabetic ketoacidosis (DKA) is the triad of hyperglycaemia, ketonaemia and metabolic acidosis. The pathogenesis of DKA involves a relative insulin deficiency and an excess of counterregulatory hormones.1 Interplay between these factors results in reduced glucose utilisation and increased gluconeogenesis, together with increased lipolysis and ketogenesis. DKA is classically associated with type 1 diabetes mellitus (DM1) but it has been increasingly recognised that it may also occur in type 2 diabetes mellitus (DM2).2 Pancreatic adenocarcinoma presenting as DKA, however, is rare; only two other cases have been reported. The first involved a 75-year-old woman with longstanding DM2 who presented with DKA; pancreatic adenocarcinoma was later diagnosed.3 The second case was in a 36-year-old woman with a history of gestational diabetes; Clinical record