Diabetic Ketoacidosis: the Usual Villain or a Scapegoat?
A novel cause of severe metabolic acidosis in type 1 diabetes
- Paul Lee, MBBS and
- Lesley V. Campbell, FRACP, FRCP
- From the Department of Endocrinology, St Vincent's Hospital, Sydney, New South Wales, Australia
- Address correspondence to Dr. Paul Lee, Department of Endocrinology, St. Vincent's Hospital, Sydney, New South Wales 2010, Australia. E-mail: pcylee{at}gmail.com
We describe a case of severe metabolic acidosis in type 1 diabetes far exceeding the accompanying diabetic ketoacidosis (DKA), highlighting pitfalls to management of DKA by protocol alone. A 19-year-old woman with type 1 diabetes since age 4 years presented with 1 day of drowsiness. While her parents believed diabetes control was satisfactory (21 units insulin glargine nocturnally and 4–6 units insulin lispro premeals), this was not supported by the reported A1C level of 11%.
She was afebrile with blood pressure 110/65 mmHg, pulse rate 100 bpm, and central venous pressure 3 mmHg. Neurological examination revealed neither lateralizing signs nor meningism.
Biochemistry demonstrated severe …
