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Current Research in Emergency Medicine
[ ISSN : 2832-5699 ]


An Unknown Enemy in A Known Frontier

Case Report
Volume 4 - Issue 1 | Article DOI : 10.54026/CREM/1056


Dr Balasubrahmanyam CH*, Manisha C, Bharath Kumar P, Sumayya Roohi Uzma, Palepu B Gopal

Citizen’s Specialty Hospital, Nallagandla, Hyderabad, India.

Corresponding Authors

Dr Balasubrahmanyam CH, Citizen’s Specialty Hospital, Nallagandla, Hyderabad, India.

Keywords

Diabetic Ketoacidosis; Diabetic Ketoalkalosis; Metabolic Alkalosis; Chlorthalidone

Received : January 02, 2025
Published : January 21, 2025

Abstract

Diabetic Ketoalkalosis (DKAlk), a rare condition characterized by the coexistence of diabetic ketoacidosis and metabolic alkalosis, can obscure the classic presentation of ketoacidosis. We report the case of a 55-year-old male with type 2 diabetes and hypertension who presented with altered mental status, petechial rash, and drowsiness. Laboratory findings revealed severe hyperglycemia (777 mg/dL), elevated serum ketones (acetone 9.6), metabolic alkalosis (high anion gap: 26.8 mmol/L), and hypokalemia. The patient had a history of chlorthalidone use and tested positive for dengue fever. The metabolic alkalosis was attributed to diuretic-induced chloride depletion and activation of the renin-angiotensin-aldosterone system, which masked the underlying ketoacidosis. Treatment included standard diabetic ketoacidosis management with f luid resuscitation, insulin, and electrolyte correction. The patient improved significantly and was discharged on day four with an insulin regimen. This case underscores the importance of thorough acid-base analysis in hyperglycemic patients with atypical blood gas findings, particularly in the context of diuretic use or concurrent illnesses. Early recognition and prompt treatment of DKAlk are essential for favourable outcomes.