title: Diabetic ketoalkalosis after steroid pulse therapy in a patient with pancreas transplant rejection.
abstract: Diabetic ketoacidosis (DKA) is characterized by excessive production of organic acids leading to a low blood pH. Rarely, because of other complicating factors blood pH may be in the alkalemic range and the term diabetic ketoalkalosis has been coined to describe this condition. So far, less than 30 such cases have been reported in the literature. We report a 34-year-old woman who received methylprednisolone pulse therapy for the treatment of pancreas transplant rejection. Thereafter, she developed vomiting and abdominal pain. Her laboratory data showed high blood sugar, hypokalemia, alkalemic pH, elevated plasma anion gap, and significant ketonemia. She responded well to the treatment of DKA. It was concluded that an alkalemic pH does not rule out the presence of ongoing DKA. In suspected cases, changes in plasma anion gap and bicarbonate and the presence of ketonemia should be noted.
authors: Department of Internal Medicine, Endocrinology and Metabolism Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran;
authors: Mahmood
authors: M
authors: Soveid
authors: Shahrokh
authors: S
authors: Ezzatzadegan Jahromi
keywords: Alkalosis; Diabetic ketoacidosis; Steroid therapy
references: Am J Med Sci. 1993 Nov;306(5):295-300
references: 8238083
references: Curr Opin Nephrol Hypertens. 2004 Jul;13(4):451-8
references: 15199296
references: Am J Emerg Med. 2001 Oct;19(6):521-2
references: 11593475
references: Int J Clin Pract. 2009 Oct;63(10):1516-25
references: 19769708
references: Diabet Med. 1997 Oct;14(10):884-5
references: 9371483
references: Diabet Med. 2010 May;27(5):607-8
references: 20536961
references: Diabetes Care. 2009 Jul;32(7):1335-43
references: 19564476
references: West J Med. 1988 Aug;149(2):217-9
references: 3150188
references: Chest. 1996 Jul;110(1):273-5
references: 8681639